Provider Demographics
NPI:1326496902
Name:WHOLEHEARTED HEALING COUNSELING LLC
Entity type:Organization
Organization Name:WHOLEHEARTED HEALING COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-824-5899
Mailing Address - Street 1:271B S CULVER ST STE H
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4805
Mailing Address - Country:US
Mailing Address - Phone:719-290-0525
Mailing Address - Fax:
Practice Address - Street 1:271B S CULVER ST STE H
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4805
Practice Address - Country:US
Practice Address - Phone:678-824-5899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008888101YP2500X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12573679OtherCAQH