Provider Demographics
NPI:1508509720
Name:HEAL, LLC
Entity Type:Organization
Organization Name:HEAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:863-606-8097
Mailing Address - Street 1:2033 E EDGEWOOD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3660
Mailing Address - Country:US
Mailing Address - Phone:863-606-8097
Mailing Address - Fax:
Practice Address - Street 1:2033 E EDGEWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3660
Practice Address - Country:US
Practice Address - Phone:863-606-8097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty