Provider Demographics
NPI:1700473162
Name:HOPE FOR SHATTERED HEART LLC
Entity type:Organization
Organization Name:HOPE FOR SHATTERED HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-270-9268
Mailing Address - Street 1:4778 ROSE ARBOR DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8354
Mailing Address - Country:US
Mailing Address - Phone:470-270-9268
Mailing Address - Fax:770-334-2493
Practice Address - Street 1:4778 ROSE ARBOR DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8354
Practice Address - Country:US
Practice Address - Phone:470-270-9268
Practice Address - Fax:770-334-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty