Provider Demographics
NPI:1396951398
Name:HEINLEN, DONNA KAY (LPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:HEINLEN
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 1:230 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2776
Mailing Address - Country:US
Mailing Address - Phone:770-716-8602
Mailing Address - Fax:
Practice Address - Street 1:23 EASTBROOK BND
Practice Address - Street 2:SUITE 200
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1565
Practice Address - Country:US
Practice Address - Phone:770-486-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 002383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health