Provider Demographics
NPI:1942530605
Name:NIX, HEATHER FLAHERTY (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:FLAHERTY
Last Name:NIX
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4067 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-302-1223
Mailing Address - Fax:
Practice Address - Street 1:6501 VETERANS PKWY
Practice Address - Street 2:SUITE 2F
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3175
Practice Address - Country:US
Practice Address - Phone:706-221-0112
Practice Address - Fax:706-221-0114
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional