Provider Demographics
NPI:1699239509
Name:HEARTSEASE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:HEARTSEASE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-677-5199
Mailing Address - Street 1:2231 VICTORY LN.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-677-5199
Mailing Address - Fax:205-778-4311
Practice Address - Street 1:2231 VICTORY LN.
Practice Address - Street 2:SUITE 500
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-677-5199
Practice Address - Fax:205-778-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1356827836Medicaid