Provider Demographics
NPI:1700408622
Name:HEROS ADVOCACY GROUP LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:HEROS ADVOCACY GROUP LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-607-5807
Mailing Address - Street 1:1819 S DOBSON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5665
Mailing Address - Country:US
Mailing Address - Phone:480-687-0680
Mailing Address - Fax:480-687-0022
Practice Address - Street 1:1819 S DOBSON RD STE 203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5665
Practice Address - Country:US
Practice Address - Phone:480-687-0680
Practice Address - Fax:480-687-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty