Provider Demographics
NPI:1528546553
Name:HENDLEY, HEATHER NICOLE (LCSW SW 17644)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:HENDLEY
Suffix:
Gender:F
Credentials:LCSW SW 17644
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88519 WAXWING CT
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2646
Mailing Address - Country:US
Mailing Address - Phone:706-537-4164
Mailing Address - Fax:
Practice Address - Street 1:76011 WILLIAM BURGESS RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5428
Practice Address - Country:US
Practice Address - Phone:904-427-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL125741041C0700X
FL176441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical