Provider Demographics
NPI:1598219693
Name:JAMES, HEATHER ANNE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA LCADC
Mailing Address - Street 1:517 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1357
Mailing Address - Country:US
Mailing Address - Phone:414-232-4034
Mailing Address - Fax:
Practice Address - Street 1:517 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1357
Practice Address - Country:US
Practice Address - Phone:414-232-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
262815101YA0400X
KY262640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)