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General NPI Number Information
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NPI Number | 1265043301
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Entity Type | Organization
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Legal Business Name | HEART & SOUL WELLNESS SOLUTIONS LLC
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 4752 PEPPER TREE LANE
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 404-232-0797
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Fax |
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Provider Business Mailing Address
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Address Line | 8486 CAMPBELLTON ST UNIT 172
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City | DOUGLASVILLE
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State | GA
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Zip | 30133-0047
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Country | US
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Telephone | 404-232-0797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATANYA FARRAR
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Credential | LCSW
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Telephone | 404-232-0979
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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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