Provider Demographics
NPI:1841732492
Name:HEALING HEARTS EXPRESSIVE ARTS, LLC
Entity type:Organization
Organization Name:HEALING HEARTS EXPRESSIVE ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-269-0190
Mailing Address - Street 1:136 HIGHWAY 138 SW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4008
Mailing Address - Country:US
Mailing Address - Phone:470-269-0190
Mailing Address - Fax:
Practice Address - Street 1:136 HIGHWAY 138 SW
Practice Address - Street 2:SUITE 400
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4008
Practice Address - Country:US
Practice Address - Phone:470-269-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health