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General NPI Number Information
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NPI Number | 1841732492
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Entity Type | Organization
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Legal Business Name | HEALING HEARTS EXPRESSIVE ARTS, LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 136 HIGHWAY 138 SW SUITE 400
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City | RIVERDALE
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State | GA
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Zip | 30274-4008
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Country | US
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Telephone | 470-269-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 136 HIGHWAY 138 SW SUITE 400
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City | RIVERDALE
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State | GA
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Zip | 30274-4008
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Country | US
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Telephone | 470-269-0190
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. GABRIELLE RENE WATERS
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Credential | LPC
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Telephone | 470-269-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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