Provider Demographics
NPI:1649432410
Name:HEART2HEART INTEGRATIVE COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:HEART2HEART INTEGRATIVE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, NCC, BCPC
Authorized Official - Phone:407-595-6393
Mailing Address - Street 1:445 DOUGLAS AVE STE 200512
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2517
Mailing Address - Country:US
Mailing Address - Phone:407-595-6393
Mailing Address - Fax:407-682-1053
Practice Address - Street 1:445 DOUGLAS AVE STE 200512
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2517
Practice Address - Country:US
Practice Address - Phone:407-595-6393
Practice Address - Fax:407-682-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty