Provider Demographics
NPI:1417547175
Name:OWENS-KNOX, HEATHER JEANNAE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEANNAE
Last Name:OWENS-KNOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 GLOUCESTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-3461
Mailing Address - Country:US
Mailing Address - Phone:912-270-3390
Mailing Address - Fax:
Practice Address - Street 1:128 FRANCES MEEKS WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3983
Practice Address - Country:US
Practice Address - Phone:912-508-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health