Provider Demographics
NPI:1164506846
Name:DAMRON, HEATHER S (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:DAMRON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 NW 23RD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6560
Mailing Address - Country:US
Mailing Address - Phone:352-379-4665
Mailing Address - Fax:352-377-0002
Practice Address - Street 1:4432 NW 23RD AVE STE 4
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6560
Practice Address - Country:US
Practice Address - Phone:352-379-4665
Practice Address - Fax:352-377-0002
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6211101YA0400X, 101YM0800X, 101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist