Provider Demographics
NPI:1821325911
Name:HEINSEN, RACHAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HEINSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:SOUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BRADLEY PARK CT STE 1B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3636
Mailing Address - Country:US
Mailing Address - Phone:706-617-5510
Mailing Address - Fax:706-327-1444
Practice Address - Street 1:4 BRADLEY PARK CT STE 1B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3636
Practice Address - Country:US
Practice Address - Phone:706-617-5510
Practice Address - Fax:706-327-1444
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51812106H00000X
GA1265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist