Provider Demographics
NPI:1649991787
Name:MCCORMACK, HEIDI (LCSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 HUNTSVILLE QUALITY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-7395
Mailing Address - Country:US
Mailing Address - Phone:270-934-2024
Mailing Address - Fax:
Practice Address - Street 1:263 HUNTSVILLE QUALITY RD STE A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-7395
Practice Address - Country:US
Practice Address - Phone:270-934-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2570661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical