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General NPI Number Information
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NPI Number | 1033683495
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Entity Type | Organization
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Legal Business Name | HEART TREE LLC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 315 W PONCE DE LEON AVE STE 480
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City | DECATUR
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State | GA
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Zip | 30030-2489
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Country | US
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Telephone | 404-375-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 300 COLONIAL CENTER PKWY STE 100N
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City | ROSWELL
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State | GA
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Zip | 30076-4892
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Country | US
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Telephone | 404-375-4448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANNAH S GOODELL
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Credential | LPC
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Telephone | 404-375-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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