Provider Demographics
NPI:1215138300
Name:LINDO, HEATHER LESLIE (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LESLIE
Last Name:LINDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, C-ACYFSW
Mailing Address - Street 1:4327 S HWY 27
Mailing Address - Street 2:PMB 203
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:704-706-4528
Mailing Address - Fax:704-749-8612
Practice Address - Street 1:17011 STATE ROAD 50 STE 301
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8203
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13438193400000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No193400000XGroupSingle Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0248052-00Medicaid
NC6106388Medicaid