Heavenly Therapeutic Services LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

HEAVENLY THERAPEUTIC SERVICES LLC

Practice address

110 Habersham Dr
Ste 116
Fayetteville, GA 30214-1381

Phone

(770) 946-2312

NPI assigned

Sep 4, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fredric Darnell BlockerNPI 1639570039

Title

LPC

Phone

(770) 946-2312

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fredric Darnell Blocker, LPC

  • Professional Counselor
  • Fayetteville, GA
  • NPI 1639570039
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1184025587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HABERSHAM DR",
            "address_2": "STE 116",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HABERSHAM DR",
            "address_2": "STE 116",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141381",
            "telephone_number": "770-946-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY THERAPEUTIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "BLOCKER",
        "authorized_official_first_name": "FREDRIC",
        "authorized_official_middle_name": "DARNELL",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "770-946-2312"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.