Healthcare Provider Details

I. General information

NPI: 1477498475
Provider Name (Legal Business Name): FIRESIDE MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LONG SHOALS RD STE B405
ARDEN NC
28704-5544
US

IV. Provider business mailing address

4 LONG SHOALS RD STE B405
ARDEN NC
28704-5544
US

V. Phone/Fax

Practice location:
  • Phone: 954-683-1923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: HEATHER STRAUSS
Title or Position: OWNER
Credential:
Phone: 954-683-1923