Provider Demographics
NPI:1710554654
Name:RESTORING HEARTS OF GEORGIA COUNSELING
Entity Type:Organization
Organization Name:RESTORING HEARTS OF GEORGIA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRAKIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-200-6644
Mailing Address - Street 1:1950 FAIRWAY CLOSE TER
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6027
Mailing Address - Country:US
Mailing Address - Phone:678-200-6644
Mailing Address - Fax:888-876-6566
Practice Address - Street 1:1950 FAIRWAY CLOSE TER
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-6027
Practice Address - Country:US
Practice Address - Phone:678-200-6644
Practice Address - Fax:888-876-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health