Organization
HER VILLAGE FOUNADATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE JANELLE GILL BA, MA (OWNER)
(718) 570-3446
Entity
Organization
Contact information
Practice address
8341 GRADY ST, DOUGLASVILLE, GA 30134-6910
(718) 570-3446
Mailing address
8341 GRADY ST, DOUGLASVILLE, GA 30134-6910
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/20/2019
Last updated
07/20/2019
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