Provider Demographics
NPI:1437822566
Name:BLACKWELL, HEATHER STOWE (BCABA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:STOWE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARISA
Other - Last Name:STOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:208 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3324
Mailing Address - Country:US
Mailing Address - Phone:252-621-1366
Mailing Address - Fax:833-901-0431
Practice Address - Street 1:208 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-621-1366
Practice Address - Fax:883-901-0431
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-18-62981106S00000X
NC0-23-14756106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician