| Black Swan Enterprises | |
|
2801 Buford Hwy Ne Ste 501 Atlanta GA 30329-2149 | |
| (404) 832-0604 | |
| Not Available |
| Full Name | Black Swan Enterprises |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2801 Buford Hwy Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Mikaela Nicole Heard (OWNER, LEAD THERAPIST) |
| Authorized Official Contact | 4048320604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Swan Enterprises 1313 Oak St Sw Atlanta GA 30310-1653 Ph: (678) 748-0128 | Black Swan Enterprises 2801 Buford Hwy Ne Ste 501 Atlanta GA 30329-2149 Ph: (404) 832-0604 |
| NPI Number | 1033556659 |
|---|---|
| Provider Enumeration Date | 05/23/2013 |
| Last Update Date | 06/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033556659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC007304 (Georgia) | Primary |
| 251S00000X | Community/behavioral Health | LPC007304 (Georgia) | Secondary |
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