Healthcare Provider Details

I. General information

NPI: 1104231356
Provider Name (Legal Business Name): SHEA HEYWARD LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 LEMONGRASS LN
CHARLOTTE NC
28214-0404
US

IV. Provider business mailing address

3115 LEMONGRASS LN
CHARLOTTE NC
28214-0404
US

V. Phone/Fax

Practice location:
  • Phone: 843-298-0163
  • Fax:
Mailing address:
  • Phone: 843-298-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP008306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: