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General NPI Number Information
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NPI Number | 1679190904
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Entity Type | Individual
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Provider Name | HEATHER NICOLE FORWARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 5950 LIVE OAK PKWY STE 240
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City | NORCROSS
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State | GA
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Zip | 30093-1743
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Country | US
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Telephone | 770-892-1697
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Fax | 770-461-0507
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Provider Business Mailing Address
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Address Line | 733 TANNERS POINT DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-8120
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Country | US
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Telephone | 678-622-7268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MSW007496
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License Number State | GA
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