Healthcare Provider Details

I. General information

NPI: 1689992463
Provider Name (Legal Business Name): HEATHER HURD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 S 17TH ST
WILMINGTON NC
28401-6600
US

IV. Provider business mailing address

2029 S 17TH ST
WILMINGTON NC
28401-6600
US

V. Phone/Fax

Practice location:
  • Phone: 910-798-6587
  • Fax: 910-798-6643
Mailing address:
  • Phone: 910-798-6587
  • Fax: 910-798-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006535
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: