Provider Demographics
NPI:1093150211
Name:WILCOXON, HEATHER L (LCMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WILCOXON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HANOVER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1312
Mailing Address - Country:US
Mailing Address - Phone:603-448-0126
Mailing Address - Fax:603-448-6001
Practice Address - Street 1:122 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2679
Practice Address - Country:US
Practice Address - Phone:603-542-5449
Practice Address - Fax:603-542-5455
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH982101YM0800X
FLMH 11325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3088608Medicaid
NH3088608Medicaid