Provider Demographics
NPI:1740834746
Name:HEART TO HEART THERAPEUTIC SERVICES INC
Entity type:Organization
Organization Name:HEART TO HEART THERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-933-0793
Mailing Address - Street 1:1613 BETHANY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:716 ANDERSON ST STE B
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-2148
Practice Address - Country:US
Practice Address - Phone:864-933-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1336Medicaid