Provider Demographics
NPI:1366848376
Name:HEATH, DELANO M (LADC)
Entity type:Individual
Prefix:
First Name:DELANO
Middle Name:M
Last Name:HEATH
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:65 PORTLAND STREET
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0384
Mailing Address - Country:US
Mailing Address - Phone:802-888-0079
Mailing Address - Fax:802-888-0116
Practice Address - Street 1:65 PORTLAND STREET
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-0384
Practice Address - Country:US
Practice Address - Phone:802-888-0079
Practice Address - Fax:802-888-0116
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)