Provider Demographics
NPI:1821104894
Name:LIDDLE, APRIL HEATHER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:APRIL
Middle Name:HEATHER
Last Name:LIDDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:APRIL
Other - Middle Name:HEATHER
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1955 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-209-6062
Mailing Address - Fax:904-209-6002
Practice Address - Street 1:1955 US HIGHWAY 1 S
Practice Address - Street 2:SUITE C-2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-209-6062
Practice Address - Fax:904-209-6002
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW74081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD516ZMedicare PIN