Provider Demographics
NPI:1073869491
Name:HEALING HEARTS COUNSELING CENTER
Entity Type:Organization
Organization Name:HEALING HEARTS COUNSELING CENTER
Other - Org Name:KRISTEN D RUDY SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATR, NCC, LPC
Authorized Official - Phone:910-777-1866
Mailing Address - Street 1:4014 OLEANDER DR
Mailing Address - Street 2:STE 3A BLDG D
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6849
Mailing Address - Country:US
Mailing Address - Phone:910-777-1866
Mailing Address - Fax:910-777-5680
Practice Address - Street 1:4014 OLEANDER DR
Practice Address - Street 2:STE 3A BLDG D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6849
Practice Address - Country:US
Practice Address - Phone:910-777-1866
Practice Address - Fax:910-777-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC154X1OtherBCBSNC
NC6104288Medicaid