Provider Demographics
NPI:1184378739
Name:SUTHERLAND( REIS), HEATHER DAWN (BT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:SUTHERLAND( REIS)
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 DEERFIELD CROSSING DR APT 16204
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1854
Mailing Address - Country:US
Mailing Address - Phone:678-622-7398
Mailing Address - Fax:
Practice Address - Street 1:1 DUNWOODY PARK STE 220
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7404
Practice Address - Country:US
Practice Address - Phone:470-702-9400
Practice Address - Fax:470-408-2282
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician