Provider Demographics
NPI:1780940890
Name:MORAN, HEIDI LOUISE (MLADC)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LOUISE
Last Name:MORAN
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 COUNTY FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-6026
Mailing Address - Country:US
Mailing Address - Phone:603-516-8164
Mailing Address - Fax:603-749-3983
Practice Address - Street 1:272 COUNTY FARM ROAD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-6026
Practice Address - Country:US
Practice Address - Phone:603-516-8164
Practice Address - Fax:603-749-3983
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60211219101YA0400X
NHMLADC 0572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)