Provider Demographics
NPI:1639931819
Name:HEATHERMAULDINLCSW LLC
Entity Type:Organization
Organization Name:HEATHERMAULDINLCSW LLC
Other - Org Name:READY TO HEAL/GROW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-803-3223
Mailing Address - Street 1:4111 BLACK PINE RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9116
Mailing Address - Country:US
Mailing Address - Phone:530-803-3223
Mailing Address - Fax:
Practice Address - Street 1:4111 BLACK PINE RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-9116
Practice Address - Country:US
Practice Address - Phone:530-803-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty