Provider Demographics
NPI:1326336520
Name:ROBERTSON MLOGANOSKI, HEATHER JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JEAN
Last Name:ROBERTSON MLOGANOSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 COURTYARD E
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-2420
Mailing Address - Country:US
Mailing Address - Phone:252-732-4007
Mailing Address - Fax:
Practice Address - Street 1:710 ARENDELL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4278
Practice Address - Country:US
Practice Address - Phone:252-732-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional