Provider Demographics
NPI:1235439167
Name:HEALING HEARTS
Entity Type:Organization
Organization Name:HEALING HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRATIANA
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-209-9420
Mailing Address - Street 1:PO BOX 962671
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6926
Mailing Address - Country:US
Mailing Address - Phone:678-209-9420
Mailing Address - Fax:
Practice Address - Street 1:110 EAGLE SPRINGS DR
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6488
Practice Address - Country:US
Practice Address - Phone:678-209-9420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health