Provider Demographics
NPI:1356834428
Name:MACLEOD, HEATHER GLENN (LICSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:GLENN
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-4732
Mailing Address - Country:US
Mailing Address - Phone:612-968-9238
Mailing Address - Fax:
Practice Address - Street 1:2617 7TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1803
Practice Address - Country:US
Practice Address - Phone:205-860-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3857C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical