Provider Demographics
NPI:1114590445
Name:THOMPSON, HEATHER (ALC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MEDICAL PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5364
Mailing Address - Country:US
Mailing Address - Phone:334-222-1818
Mailing Address - Fax:334-222-1919
Practice Address - Street 1:109 MEDICAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5364
Practice Address - Country:US
Practice Address - Phone:334-222-1818
Practice Address - Fax:334-222-1919
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05047101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor