| Heavenly Therapeutic Services Llc | |
|
110 Habersham Dr Ste 116 Fayetteville GA 30214-1381 | |
| (770) 946-2312 | |
| Not Available |
| Full Name | Heavenly Therapeutic Services Llc |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 09/04/2014 |
| Last Update Date | 09/04/2014 |
| Medicare PECOS PAC ID | 1456797794 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639570039 PECOS PAC ID: 3173969417 Enrollment ID: I20240309000234 |
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