MEDICARE: HEALING MINDS, HELPING 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	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1922613785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING MINDS, HELPING HEARTS, LLC

Provider Business Mailing Address
First Line	:	2532 N DECATUR RD APT 1304
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 N DECATUR RD
Second Line	:	APT 1304
City	:	DECATUR
State	:	GA
Zip	:	30033
Country	:	US
Telephone Number	:	404-590-4404
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER/THERAPIST
Name	:	TORQUESIA SMITH
Credential	:	LCSW
Telephone Number	:	404-590-4404

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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