Intentional Hearts, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

LPC004107 Issued in GA

Legal business name

INTENTIONAL HEARTS, INC.

Practice address

4200 Northside Pkwy NW
BLDG 1, Ste 200
Atlanta, GA 30327-3054

Phone

(770) 623-3331

NPI assigned

Feb 23, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Todd Wilson, LPC

Title

President

Phone

(770) 623-3331

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235347200000",
    "number": "1003056698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 NORTHSIDE PKWY NW",
            "address_2": "BLDG 1, STE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303273054",
            "telephone_number": "770-623-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 NORTHSIDE PKWY NW",
            "address_2": "BLDG 1, STE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303273054",
            "telephone_number": "770-623-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL HEARTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-23",
        "last_updated": "2009-02-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MICHAEL TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-623-3331",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "LPC004107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.