Provider Demographics
NPI:1801138805
Name:SUMNER, HEATHER MCLAINE (CAC II)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MCLAINE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 THUNDERBOLT DR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-9341
Mailing Address - Country:US
Mailing Address - Phone:843-538-4343
Mailing Address - Fax:843-538-7613
Practice Address - Street 1:1439 THUNDERBOLT DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-9341
Practice Address - Country:US
Practice Address - Phone:843-538-4343
Practice Address - Fax:843-538-7613
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12042625101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)