Healthcare Provider Details

I. General information

NPI: 1144839416
Provider Name (Legal Business Name): HEART SONG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WEST AVE
GAINESVILLE GA
30501-4247
US

IV. Provider business mailing address

605 WEST AVE
GAINESVILLE GA
30501-4247
US

V. Phone/Fax

Practice location:
  • Phone: 678-936-4269
  • Fax:
Mailing address:
  • Phone: 678-936-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONI MIQUEL SHANINE
Title or Position: OWNER
Credential: MT-BC, LMT
Phone: 678-936-4269