Organization
BLACK SWAN ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIKAELA NICOLE HEARD M.ED, LPC (OWNER, LEAD THERAPIST)
(404) 832-0604
Entity
Organization
Contact information
Practice address
2801 BUFORD HWY NE, STE 501, ATLANTA, GA 30329-2149
(404) 832-0604
Mailing address
1313 OAK ST SW, ATLANTA, GA 30310-1653
(678) 748-0128
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007304
GA
251S00000X
Community/Behavioral Health Agency
LPC007304
GA
Other
Enumeration date
05/23/2013
Last updated
06/12/2014
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