Organization
HEAVENLY THERAPEUTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDRIC DARNELL BLOCKER (LPC)
(770) 946-2312
Entity
Organization
Contact information
Practice address
110 HABERSHAM DR, STE 116, FAYETTEVILLE, GA 30214-1381
(770) 946-2312
Mailing address
110 HABERSHAM DR, STE 116, FAYETTEVILLE, GA 30214-1381
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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