Provider Demographics
NPI:1740932979
Name:KING, HEATHER JANET
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JANET
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S SKINNER AVE
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3225
Mailing Address - Country:US
Mailing Address - Phone:912-412-7178
Mailing Address - Fax:912-888-1192
Practice Address - Street 1:62 SAGO PALM DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9502
Practice Address - Country:US
Practice Address - Phone:843-259-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12696104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker