Heavenly Therapeutic Services Llc | |
110 Habersham Dr Ste 116 Fayetteville GA 30214-1381 | |
(770) 946-2312 | |
Not Available |
Full Name | Heavenly Therapeutic Services Llc |
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Speciality | Counselor |
Location | 110 Habersham Dr, Fayetteville, Georgia |
Authorized Official Name and Position | Fredric Darnell Blocker (LPC) |
Authorized Official Contact | 7709462312 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Heavenly Therapeutic Services Llc 110 Habersham Dr Ste 116 Fayetteville GA 30214-1381 Ph: () - | Heavenly Therapeutic Services Llc 110 Habersham Dr Ste 116 Fayetteville GA 30214-1381 Ph: (770) 946-2312 |
NPI Number | 1184025587 |
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Provider Enumeration Date | 09/04/2014 |
Last Update Date | 09/04/2014 |
Medicare PECOS PAC ID | 1456797794 |
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Medicare Enrollment ID | O20240309000160 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184025587 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Fredric D Blocker |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1639570039 PECOS PAC ID: 3173969417 Enrollment ID: I20240309000234 |
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