Provider Demographics
NPI:1447594676
Name:ROE, HEATHER (MS, LMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8723
Mailing Address - Country:US
Mailing Address - Phone:321-480-9002
Mailing Address - Fax:
Practice Address - Street 1:720 E NEW HAVEN AVE STE 11
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5474
Practice Address - Country:US
Practice Address - Phone:321-480-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health