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General NPI Number Information
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NPI Number | 1700473162
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Entity Type | Organization
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Legal Business Name | HOPE FOR SHATTERED HEART LLC
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 708 OSBORNE ST STE 104
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City | SAINT MARYS
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State | GA
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Zip | 31558-8497
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Country | US
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Telephone | 470-270-9268
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Fax | 915-576-5315
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Provider Business Mailing Address
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Address Line | 708 OSBORNE ST STE 104
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City | SAINT MARYS
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State | GA
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Zip | 31558-8497
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Country | US
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Telephone | 470-270-9268
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Fax | 770-334-2493
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATRICIA JACKSON WHALEN
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Credential |
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Telephone | 470-270-9268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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