Provider Demographics
NPI:1982859880
Name:HEATH, THERESA MORGAN (LCAS, LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MORGAN
Last Name:HEATH
Suffix:
Gender:F
Credentials:LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 MEDICAL CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4250
Mailing Address - Country:US
Mailing Address - Phone:910-990-9688
Mailing Address - Fax:910-990-9688
Practice Address - Street 1:736 MEDICAL CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4250
Practice Address - Country:US
Practice Address - Phone:910-763-5979
Practice Address - Fax:910-763-4935
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1323101YA0400X
NCC0067131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)