Healthcare Provider Details

I. General information

NPI: 1003133158
Provider Name (Legal Business Name): HEATHER JOY SPOTTS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710-1712 E. MICHIGAN AVE
LANSING MI
48848
US

IV. Provider business mailing address

6708 HIGHLAND DR
LAINGSBURG MI
48848-9203
US

V. Phone/Fax

Practice location:
  • Phone: 517-372-9163
  • Fax: 517-372-7981
Mailing address:
  • Phone: 517-651-1435
  • Fax: 517-651-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801066459
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: