=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386975761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER WINGERT LCSW, LCAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2010
-----------------------------------------------------
Last Update Date | 04/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 WOODWARD AVE
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28804-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-333-2426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 WOODWARD AVE
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28804-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-333-2426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C006687
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------