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NPI Code Detail

MEDICARE: HEATHER WILLARD LPC

MEDICARE: HEATHER WILLARD LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor009655GA

General Provider Information

NPI Number : 1497277297
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER WILLARD LPC
Provider Business Mailing Address
First Line : 4718 QUIET MEADOW LN
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542-3743
Country : US
Telephone Number : 770-633-8343
Fax Number :
Provider Business Practice Location Address
First Line : 129 N MAIN ST
Second Line :
City : CLEVELAND
State : GA
Zip : 30528-1123
Country : US
Telephone Number : 706-348-4060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2017
Last Update Date : 07/13/2017

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Directions to “ HEATHER WILLARD LPC” Practice Location

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