Healthcare Provider Details

I. General information

NPI: 1467580688
Provider Name (Legal Business Name): HEATHER LYNN SURBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER LYNN MARTIN

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9238 MADISON BLVD STE 116
MADISON AL
35758-9112
US

IV. Provider business mailing address

9238 MADISON BLVD STE 116
MADISON AL
35758-9112
US

V. Phone/Fax

Practice location:
  • Phone: 256-542-3288
  • Fax: 256-542-3289
Mailing address:
  • Phone: 256-542-3288
  • Fax: 256-542-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1564C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3363
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3661C
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: