Provider Demographics
NPI:1932754561
Name:LAKE MARY COUNSELING
Entity Type:Organization
Organization Name:LAKE MARY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-416-3840
Mailing Address - Street 1:536 BOTTLEBRUSH LOOP
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-0037
Mailing Address - Country:US
Mailing Address - Phone:407-416-3840
Mailing Address - Fax:407-787-5352
Practice Address - Street 1:310 WAYMONT CT STE 100
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3475
Practice Address - Country:US
Practice Address - Phone:407-635-1979
Practice Address - Fax:321-926-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty