Provider Demographics
NPI:1851578413
Name:HEATH, SALLY A (MSW, LICSW, CDP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:A
Last Name:HEATH
Suffix:
Gender:F
Credentials:MSW, LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:WA
Mailing Address - Zip Code:98559-0914
Mailing Address - Country:US
Mailing Address - Phone:360-584-8522
Mailing Address - Fax:
Practice Address - Street 1:2629 PARKMONT LN SW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5782
Practice Address - Country:US
Practice Address - Phone:360-584-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00035442101Y00000X
WACP00002863101YA0400X
WALW600177761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)