Provider Demographics
NPI:1073894754
Name:HEARD, MIKAELA NICOLE (LAPC)
Entity Type:Individual
Prefix:MISS
First Name:MIKAELA
Middle Name:NICOLE
Last Name:HEARD
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 OAK ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1653
Mailing Address - Country:US
Mailing Address - Phone:678-748-0128
Mailing Address - Fax:
Practice Address - Street 1:2484 INGLESIDE AVE
Practice Address - Street 2:D202
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2089
Practice Address - Country:US
Practice Address - Phone:678-748-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health