Provider Demographics
NPI:1497015374
Name:HEATH, HEATHER D (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:HEATH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 LENOX AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4745
Mailing Address - Country:US
Mailing Address - Phone:904-642-5232
Mailing Address - Fax:
Practice Address - Street 1:5310 LENOX AVE STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4745
Practice Address - Country:US
Practice Address - Phone:904-642-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81735101YP2500X
FLMH16326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional