Provider Demographics
NPI:1598803520
Name:SMITH, HEATHER ANN (MED, LPCS, LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, LPCS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARBORDALE LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6771
Mailing Address - Country:US
Mailing Address - Phone:864-680-7392
Mailing Address - Fax:
Practice Address - Street 1:6 ARBORDALE LN
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6771
Practice Address - Country:US
Practice Address - Phone:864-680-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional