Provider Demographics
NPI:1760642680
Name:HEARD, ZSA ZSA (LPC)
Entity Type:Individual
Prefix:
First Name:ZSA ZSA
Middle Name:
Last Name:HEARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111B CORPORATE PARK EAST DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3680
Mailing Address - Country:US
Mailing Address - Phone:706-884-1080
Mailing Address - Fax:706-812-8866
Practice Address - Street 1:111B CORPORATE PARK EAST DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3680
Practice Address - Country:US
Practice Address - Phone:706-884-1080
Practice Address - Fax:706-812-8866
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514073675AMedicaid