MEDICARE: BRAVEHEART COACHING AND COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1174473581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVEHEART COACHING AND COUNSELING

Provider Business Mailing Address
First Line	:	3269 CASCADE PARC BLVD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5204
Country	:	US
Telephone Number	:	404-402-8729
Fax Number	:

Provider Business Practice Location Address
First Line	:	3269 CASCADE PARC BLVD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5204
Country	:	US
Telephone Number	:	404-402-8729
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	LONDON PARKS
Credential	:	LPC
Telephone Number	:	404-402-8729

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “BRAVEHEART COACHING AND COUNSELING ” Practice Location

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