Provider Demographics
NPI:1497214456
Name:HEATHER KOTLERLCSW MPH LLC
Entity Type:Organization
Organization Name:HEATHER KOTLERLCSW MPH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:I
Authorized Official - Last Name:KOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW MPH
Authorized Official - Phone:404-798-7228
Mailing Address - Street 1:215 CHURCH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3330
Mailing Address - Country:US
Mailing Address - Phone:404-798-7228
Mailing Address - Fax:
Practice Address - Street 1:215 CHURCH ST STE 109
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3330
Practice Address - Country:US
Practice Address - Phone:404-798-7228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health