Healthcare Provider Details

I. General information

NPI: 1891107207
Provider Name (Legal Business Name): HEALING LINK PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 S BERKELEY LAKE RD
BERKELEY LAKE GA
30071-1660
US

IV. Provider business mailing address

4530 S BERKELEY LAKE RD
BERKELEY LAKE GA
30071-1660
US

V. Phone/Fax

Practice location:
  • Phone: 770-446-5642
  • Fax: 770-446-5643
Mailing address:
  • Phone: 770-446-5642
  • Fax: 770-446-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLPC007732
License Number StateGA

VIII. Authorized Official

Name: NAJAMULSAHR MEHMOOD
Title or Position: OWNER
Credential: LPC
Phone: 770-598-9475