MEDICARE: INTELLECTUAL HEARTS LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346073723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTELLECTUAL HEARTS LLC

Provider Business Mailing Address
First Line	:	7612 BROOKWOOD VALLEY LN
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-9722
Country	:	US
Telephone Number	:	980-279-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	7612 BROOKWOOD VALLEY LN
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-9722
Country	:	US
Telephone Number	:	980-279-7836
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CHANDRA DENISE WILLIAMS
Credential	:	LCMHC, LCASA
Telephone Number	:	980-279-7836

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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Directions to “INTELLECTUAL HEARTS LLC ” Practice Location

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