Provider Demographics
NPI:1760978704
Name:HEARTSWELL, LLC
Entity Type:Organization
Organization Name:HEARTSWELL, LLC
Other - Org Name:HEARTSWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-220-0951
Mailing Address - Street 1:1600 WILSON BLVD STE 702
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2505
Mailing Address - Country:US
Mailing Address - Phone:703-220-0951
Mailing Address - Fax:
Practice Address - Street 1:1600 WILSON BLVD STE 702
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2505
Practice Address - Country:US
Practice Address - Phone:703-220-0951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040076711041C0700X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty