Provider Demographics
NPI:1083366629
Name:HEIDI COLLIER, LICSW LLC
Entity Type:Organization
Organization Name:HEIDI COLLIER, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:334-456-8809
Mailing Address - Street 1:27625 US HIGHWAY 98 BLDG A
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4816
Mailing Address - Country:US
Mailing Address - Phone:251-626-7959
Mailing Address - Fax:251-626-6122
Practice Address - Street 1:27625 US HIGHWAY 98 BLDG A
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4816
Practice Address - Country:US
Practice Address - Phone:251-626-7959
Practice Address - Fax:251-626-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center