Organization
INTENTIONAL HEARTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL TODD WILSON LPC (PRESIDENT)
(770) 623-3331
Entity
Organization
Contact information
Practice address
4200 NORTHSIDE PKWY NW, BLDG 1, STE 200, ATLANTA, GA 30327-3054
(770) 623-3331
Mailing address
4200 NORTHSIDE PKWY NW, BLDG 1, STE 200, ATLANTA, GA 30327-3054
(770) 623-3331
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LPC004107
GA
Other
Enumeration date
02/23/2009
Last updated
02/23/2009
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