Provider Demographics
NPI:1831748474
Name:HEDDY-REED, AUTUMN GRACE (LMSW, MED, ATR-BC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:GRACE
Last Name:HEDDY-REED
Suffix:
Gender:F
Credentials:LMSW, MED, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1154
Mailing Address - Country:US
Mailing Address - Phone:810-667-0500
Mailing Address - Fax:
Practice Address - Street 1:1570 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1154
Practice Address - Country:US
Practice Address - Phone:810-667-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18-095221700000X
MI68011146821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist