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General NPI Number Information
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NPI Number | 1861188096
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Entity Type | Individual
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Provider Name | HEATHER GROOM LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 4499 GA HIGHWAY 40 E STE A
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City | SAINT MARYS
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State | GA
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Zip | 31558-9402
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Country | US
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Telephone | 912-464-4265
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Fax |
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Provider Business Mailing Address
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Address Line | 4499 GA HIGHWAY 40 E STE A
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City | SAINT MARYS
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State | GA
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Zip | 31558-9402
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Country | US
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Telephone | 912-464-4265
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Fax | 912-729-4626
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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 | CSW009561
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License Number State | GA
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