Provider Demographics
NPI:1104231356
Name:HEYWARD, SHEA (LCSWA)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:HEYWARD
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 LEMONGRASS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-0404
Mailing Address - Country:US
Mailing Address - Phone:843-298-0163
Mailing Address - Fax:
Practice Address - Street 1:3115 LEMONGRASS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-0404
Practice Address - Country:US
Practice Address - Phone:843-298-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0083061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical