Provider Demographics
NPI:1477359206
Name:HEERY, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HEERY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 LIGON MILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8826
Mailing Address - Country:US
Mailing Address - Phone:984-206-0543
Mailing Address - Fax:
Practice Address - Street 1:7908 LIGON MILL RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8826
Practice Address - Country:US
Practice Address - Phone:984-206-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician