Organization
HER THERAPEUTIC BREAKTHROUGH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTIONETTE DOMINIQUE WASHINGTON (CEO)
(504) 908-4332
Entity
Organization
Contact information
Practice address
4370 OLD MABRY LN NE, ROSWELL, GA 30075-1927
(504) 908-4632
Mailing address
4370 OLD MABRY LN NE, ROSWELL, GA 30075-1927
(504) 908-4632
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
1041S0200X
School Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
04/14/2025
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