Organization
HEART TREE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANNAH S GOODELL LPC (OWNER)
(404) 375-4448
Entity
Organization
Contact information
Practice address
315 W PONCE DE LEON AVE STE 480, DECATUR, GA 30030-2489
(404) 375-4448
Mailing address
300 COLONIAL CENTER PKWY STE 100N, ROSWELL, GA 30076-4892
(404) 375-4448
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW4122
LICENSE
GA
Enumeration date
01/17/2019
Last updated
01/17/2019
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