Provider Demographics
NPI:1326388687
Name:BURLEY, HEATHER LUSSIER (SSP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LUSSIER
Last Name:BURLEY
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-1534
Mailing Address - Country:US
Mailing Address - Phone:843-623-2175
Mailing Address - Fax:
Practice Address - Street 1:401 WEST BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-1534
Practice Address - Country:US
Practice Address - Phone:843-623-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208152103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool