Provider Demographics
NPI:1124610332
Name:GILBERT, HEATHER NICHOLE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S LOCUS ST
Mailing Address - Street 2:
Mailing Address - City:MCARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651
Mailing Address - Country:US
Mailing Address - Phone:740-270-0714
Mailing Address - Fax:
Practice Address - Street 1:314 S LOCUS ST
Practice Address - Street 2:
Practice Address - City:MCARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651
Practice Address - Country:US
Practice Address - Phone:740-270-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174592101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)