MEDICARE: HEATHER CREECH MED, BCBA, LBA

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
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1942758990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CREECH MED, BCBA, LBA

Provider Business Mailing Address
First Line	:	8701 WADFORD DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-9028
Country	:	US
Telephone Number	:	757-635-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 WADFORD DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-9028
Country	:	US
Telephone Number	:	434-239-0003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	05/22/2025

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