Provider Demographics
NPI:1003133158
Name:SPOTTS, HEATHER JOY (LMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOY
Last Name:SPOTTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9203
Mailing Address - Country:US
Mailing Address - Phone:517-651-1435
Mailing Address - Fax:517-651-5078
Practice Address - Street 1:1710-1712 E. MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48848
Practice Address - Country:US
Practice Address - Phone:517-372-9163
Practice Address - Fax:517-372-7981
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010664591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical