Provider Demographics
NPI:1972538627
Name:HEATH-SHEPARD, HOLLY (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:HEATH-SHEPARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 STAPLES DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9464
Mailing Address - Country:US
Mailing Address - Phone:919-946-5453
Mailing Address - Fax:
Practice Address - Street 1:327 STAPLES DR
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9464
Practice Address - Country:US
Practice Address - Phone:919-946-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106345Medicaid