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General NPI Number Information
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NPI Number | 1699188367
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Entity Type | Organization
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Legal Business Name | HEALING OUR VILLAGE OF MARYLAND, INC.
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 177 N MAIN ST
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City | JONESBORO
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State | GA
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Zip | 30236-3567
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Country | US
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Telephone | 800-788-0941
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Fax |
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Provider Business Mailing Address
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Address Line | 405 BENJAMIN CIR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-3346
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LENORE COLEMAN
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Credential | PHARMD
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Telephone | 703-795-1983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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