Provider Demographics
NPI:1467580688
Name:SURBER, HEATHER LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYNN
Last Name:SURBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9238 MADISON BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9112
Mailing Address - Country:US
Mailing Address - Phone:256-542-3288
Mailing Address - Fax:256-542-3289
Practice Address - Street 1:9238 MADISON BLVD STE 116
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9112
Practice Address - Country:US
Practice Address - Phone:256-542-3288
Practice Address - Fax:256-542-3289
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1564C1041C0700X
TN33631041C0700X
AL3661C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I805034Medicare PIN