Provider Demographics
NPI:1366934697
Name:HEALING HOUSE, INC.
Entity type:Organization
Organization Name:HEALING HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-520-2593
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-0028
Mailing Address - Country:US
Mailing Address - Phone:678-520-2593
Mailing Address - Fax:
Practice Address - Street 1:5118 ASHLEY FALLS CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-9292
Practice Address - Country:US
Practice Address - Phone:678-520-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)