Provider Demographics
NPI:1952811010
Name:HEARTLIFE PROFESSIONAL SOUL CARE
Entity Type:Organization
Organization Name:HEARTLIFE PROFESSIONAL SOUL CARE
Other - Org Name:HEARTLIFE PROFESSIONAL SOUL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-756-5060
Mailing Address - Street 1:7947 PLAYERS FOREST DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-9114
Mailing Address - Country:US
Mailing Address - Phone:901-756-5060
Mailing Address - Fax:
Practice Address - Street 1:7947 PLAYERS FOREST DR STE 103
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-9114
Practice Address - Country:US
Practice Address - Phone:901-756-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty