Healthcare Provider Details

I. General information

NPI: 1063108058
Provider Name (Legal Business Name): HEATHER STYES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 GENEVA ST
OPELIKA AL
36801-5810
US

IV. Provider business mailing address

2100 GLENWOOD DRIVE
OPELIKA AL
36801
US

V. Phone/Fax

Practice location:
  • Phone: 334-610-7342
  • Fax:
Mailing address:
  • Phone: 334-610-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6435C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: