Healthcare Provider Details

I. General information

NPI: 1770315467
Provider Name (Legal Business Name): HEATHER MCALLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 STIRRUP CREEK DR
DURHAM NC
27703-9464
US

IV. Provider business mailing address

1295 VANDANA BLVD NORTH SUITE 210
ST. PAUL MN
55108
US

V. Phone/Fax

Practice location:
  • Phone: 888-364-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: