Provider Demographics
NPI:1386360782
Name:CONNORS HERBERT, HEATHER (SUDRC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CONNORS HERBERT
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-0316
Mailing Address - Country:US
Mailing Address - Phone:707-274-5610
Mailing Address - Fax:
Practice Address - Street 1:14715 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CLEARLAKE OAKS
Practice Address - State:CA
Practice Address - Zip Code:95423
Practice Address - Country:US
Practice Address - Phone:707-998-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDRC14092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)