Provider Demographics
NPI:1629879028
Name:O'CONNOR, HEIDI (LPC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SIMPSON PL
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1372
Mailing Address - Country:US
Mailing Address - Phone:229-412-5005
Mailing Address - Fax:
Practice Address - Street 1:316 SIMPSON PL
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1372
Practice Address - Country:US
Practice Address - Phone:229-412-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional