Provider Demographics
NPI:1235763020
Name:STOVER, HEATHER DAWN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:STOVER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 BUGGER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040-9388
Mailing Address - Country:US
Mailing Address - Phone:828-305-4704
Mailing Address - Fax:
Practice Address - Street 1:1300C GIDNEY ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6822
Practice Address - Country:US
Practice Address - Phone:704-484-2558
Practice Address - Fax:704-484-2042
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7335101YM0800X, 101YP2500X
NCA14734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty