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General NPI Number Information
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NPI Number | 1952811010
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Entity Type | Organization
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Legal Business Name | HEARTLIFE PROFESSIONAL SOUL CARE
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 7947 PLAYERS FOREST DR STE 103
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City | MEMPHIS
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State | TN
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Zip | 38119-9114
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Country | US
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Telephone | 901-756-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 7947 PLAYERS FOREST DR STE 103
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City | MEMPHIS
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State | TN
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Zip | 38119-9114
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Country | US
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Telephone | 901-756-5060
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST, PRESIDENT
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Name | DR. CHARLES HANNAFORD
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Credential | PH.D.
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Telephone | 901-756-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3369
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License Number State | TN
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