Provider Demographics
NPI:1205016243
Name:HEATH, DELORIS H (MS, CCJP)
Entity Type:Individual
Prefix:MS
First Name:DELORIS
Middle Name:H
Last Name:HEATH
Suffix:
Gender:F
Credentials:MS, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 DOOLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-3039
Mailing Address - Country:US
Mailing Address - Phone:256-525-6443
Mailing Address - Fax:
Practice Address - Street 1:2003 DOOLEY AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-3039
Practice Address - Country:US
Practice Address - Phone:256-525-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker