Provider Demographics
NPI:1992051783
Name:HEINZLE, ERIKA NICHOLE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:NICHOLE
Last Name:HEINZLE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:NICHOLE
Other - Last Name:SNIPES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:503 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6534
Mailing Address - Country:US
Mailing Address - Phone:706-395-5266
Mailing Address - Fax:855-700-4579
Practice Address - Street 1:1 HUNTINGTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7204
Practice Address - Country:US
Practice Address - Phone:706-395-5266
Practice Address - Fax:855-700-4579
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional