Healthcare Provider Details

I. General information

NPI: 1972376200
Provider Name (Legal Business Name): LISTENING HANDS CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CONYERS RD
LOGANVILLE GA
30052-2650
US

IV. Provider business mailing address

412 CONYERS RD
LOGANVILLE GA
30052-2650
US

V. Phone/Fax

Practice location:
  • Phone: 770-778-1702
  • Fax:
Mailing address:
  • Phone: 770-778-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: LADEIDRA WOOTEN
Title or Position: HOLISTIC REGISTERED NURSE
Credential: RN
Phone: 770-778-1702