Provider Demographics
NPI:1831781327
Name:HEALING HEARTS 4 REAL
Entity type:Organization
Organization Name:HEALING HEARTS 4 REAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIYANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCRORY LONON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-955-7296
Mailing Address - Street 1:2241 COUNTRY WALK
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3968
Mailing Address - Country:US
Mailing Address - Phone:404-955-7296
Mailing Address - Fax:
Practice Address - Street 1:2241 COUNTRY WALK
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3968
Practice Address - Country:US
Practice Address - Phone:404-955-7296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health