Provider Demographics
NPI:1457773392
Name:LOVE, HEATHER CLARK (MA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CLARK
Last Name:LOVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CAMPHOR AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2819
Mailing Address - Country:US
Mailing Address - Phone:251-943-2818
Mailing Address - Fax:251-943-2144
Practice Address - Street 1:201 E CAMPHOR AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2819
Practice Address - Country:US
Practice Address - Phone:251-943-2818
Practice Address - Fax:251-943-2144
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health