Provider Demographics
NPI:1558530212
Name:BARTLEY, MARY HEATHER (LCAS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HEATHER
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KASE CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8019
Mailing Address - Country:US
Mailing Address - Phone:704-430-6347
Mailing Address - Fax:
Practice Address - Street 1:700 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4379
Practice Address - Country:US
Practice Address - Phone:704-430-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-1306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLCAS-1306OtherNCSAPPB