Provider Demographics
NPI:1952464927
Name:HEINEN, GEORGE ALLEN III (CPSS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALLEN
Last Name:HEINEN
Suffix:III
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COLONIAL DRIVE
Mailing Address - Street 2:COTTAGE A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ENTIRE STATE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29202
Practice Address - Country:US
Practice Address - Phone:803-898-2025
Practice Address - Fax:803-898-2194
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health