Provider Demographics
NPI:1649409566
Name:ASHBY, HEATHER S
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:ASHBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14254 GOLDEN RAIN TREE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4838
Mailing Address - Country:US
Mailing Address - Phone:407-595-2452
Mailing Address - Fax:
Practice Address - Street 1:499 N STATE ROAD 434
Practice Address - Street 2:SUITE 2007
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2142
Practice Address - Country:US
Practice Address - Phone:407-291-8009
Practice Address - Fax:407-291-9620
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH7293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health