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NPI Code Detail

MEDICARE: HEATHER MATHIS LPC

MEDICARE: HEATHER MATHIS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorLPC008471GA

General Provider Information

NPI Number : 1518207489
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER MATHIS LPC
Provider Business Mailing Address
First Line : 7208 CORAL LAKE DR
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-5595
Country : US
Telephone Number : 770-365-6348
Fax Number :
Provider Business Practice Location Address
First Line : 190 CAMDEN HILL RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30046-2448
Country : US
Telephone Number : 770-513-8988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2013
Last Update Date : 06/16/2015

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Directions to “ HEATHER MATHIS LPC” Practice Location

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