Provider Demographics
NPI:1235678806
Name:HEATHER HERRICK, LMSW, PLLC
Entity Type:Organization
Organization Name:HEATHER HERRICK, LMSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-355-1585
Mailing Address - Street 1:4312 CLOVERLANE DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5058
Mailing Address - Country:US
Mailing Address - Phone:734-355-1585
Mailing Address - Fax:
Practice Address - Street 1:2311 SHELBY AVE STE 101D
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3849
Practice Address - Country:US
Practice Address - Phone:734-355-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084407251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health