Provider Demographics
NPI:1184009680
Name:HEART TO HEART COUNSELING AND LIFE ENRICHMENT SERVICES
Entity Type:Organization
Organization Name:HEART TO HEART COUNSELING AND LIFE ENRICHMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON-MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-578-6408
Mailing Address - Street 1:6664 FOXBERRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1882
Mailing Address - Country:US
Mailing Address - Phone:910-578-6408
Mailing Address - Fax:
Practice Address - Street 1:120 WESTLAKE RD STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-4451
Practice Address - Country:US
Practice Address - Phone:910-578-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417268590Medicaid
NCQ45418AOtherMEDICARE