Provider Demographics
NPI:1366827487
Name:HEALING FROM THE HEART
Entity Type:Organization
Organization Name:HEALING FROM THE HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAVELIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:CSWA
Authorized Official - Phone:971-275-9974
Mailing Address - Street 1:5425 NE 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6227
Mailing Address - Country:US
Mailing Address - Phone:971-275-9974
Mailing Address - Fax:
Practice Address - Street 1:5425 NE 27TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6227
Practice Address - Country:US
Practice Address - Phone:971-275-9974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA55131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty