Provider Demographics
NPI:1790202794
Name:MATTERS OF THE HEART COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MATTERS OF THE HEART COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-764-4697
Mailing Address - Street 1:6686 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2043
Mailing Address - Country:US
Mailing Address - Phone:678-764-4697
Mailing Address - Fax:
Practice Address - Street 1:1226 ROYAL DR SW STE M
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5926
Practice Address - Country:US
Practice Address - Phone:678-764-4697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CSW005244251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health