Provider Demographics
NPI:1073592267
Name:HEARD, PATRICIA JONES (MSW,LCSW,LMFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JONES
Last Name:HEARD
Suffix:
Gender:F
Credentials:MSW,LCSW,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 CONSTITUTION LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4216
Mailing Address - Country:US
Mailing Address - Phone:704-591-3193
Mailing Address - Fax:704-552-1493
Practice Address - Street 1:10720 CARMEL COMMONS BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3785
Practice Address - Country:US
Practice Address - Phone:704-542-9883
Practice Address - Fax:704-542-9883
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0008101041C0700X
NC380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC295322OtherMHN