Provider Demographics
NPI:1154988772
Name:THE HEALING IMPACT, INC
Entity type:Organization
Organization Name:THE HEALING IMPACT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:CHURCHMAN
Authorized Official - Last Name:ABADIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-218-3062
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 9TH AVE STE F
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1742
Practice Address - Country:US
Practice Address - Phone:505-412-5292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043853435OtherNPI
1861792467OtherNPI
1013499664OtherEMPLOYEE NPI
FL1345573506OtherNPI
FL1720560675OtherNPI