Provider Demographics
NPI:1386677482
Name:HERITAGE COUNSELING SERVICES INC.
Entity Type:Organization
Organization Name:HERITAGE COUNSELING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-449-0532
Mailing Address - Street 1:10835 BEDFORDTOWN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8060
Mailing Address - Country:US
Mailing Address - Phone:919-449-0532
Mailing Address - Fax:919-792-9551
Practice Address - Street 1:2012 S MAIN ST STE 500D
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5008
Practice Address - Country:US
Practice Address - Phone:919-449-0532
Practice Address - Fax:919-792-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004666251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002801Medicaid
NC6005326Medicaid