Provider Demographics
NPI:1710546676
Name:WILHELM, HEATHER M (LPC, CAC1)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:WILHELM
Suffix:
Gender:F
Credentials:LPC, CAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 MOSS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7455
Mailing Address - Country:US
Mailing Address - Phone:843-212-6244
Mailing Address - Fax:
Practice Address - Street 1:1143 MOSS GROVE DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7455
Practice Address - Country:US
Practice Address - Phone:843-212-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health