Provider Demographics
NPI:1275890642
Name:HERITAGE COUNSELING
Entity Type:Organization
Organization Name:HERITAGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-657-9613
Mailing Address - Street 1:1009 N COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-6828
Mailing Address - Country:US
Mailing Address - Phone:912-572-5261
Mailing Address - Fax:
Practice Address - Street 1:1009 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-6828
Practice Address - Country:US
Practice Address - Phone:912-572-5261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty