Provider Demographics
NPI:1841400413
Name:POWELL, HEATHER DAWN (BA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DAWN
Last Name:POWELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:RUCKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 OLDE COLONIAL DR
Mailing Address - Street 2:UNIT 6
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-4212
Mailing Address - Country:US
Mailing Address - Phone:617-710-9251
Mailing Address - Fax:
Practice Address - Street 1:172 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3750
Practice Address - Country:US
Practice Address - Phone:508-770-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor