Organization Name: | HERITAGE COUNSELING |
NPI Number: | 1275890642 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRACEY PACE (COUNSELOR) |
Mailing Address: | 1009 N Columbia Ave Rincon |
State: | GA US |
Postal Code: | 313266828 |
Phone Number: | 9125725261 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2012 |
NPI Last Update Date: | 04/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | APC003295 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |