Provider Demographics
NPI:1922249853
Name:FORD, HEATHER MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 W HARBOR HWY
Mailing Address - Street 2:
Mailing Address - City:MAPLE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49664-9715
Mailing Address - Country:US
Mailing Address - Phone:206-960-9833
Mailing Address - Fax:
Practice Address - Street 1:6408 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GLEN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49636-5101
Practice Address - Country:US
Practice Address - Phone:206-960-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089428171000000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171000000XOther Service ProvidersMilitary Health Care Provider