Provider Demographics
NPI:1669785390
Name:BEX, HEATHER L (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:BEX
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 1:3725 NATIONAL DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4066
Mailing Address - Country:US
Mailing Address - Phone:919-781-8370
Mailing Address - Fax:919-781-2266
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:919-781-2266
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007654Medicaid