Provider Demographics
NPI:1598803520
Name:SMITH, HEATHER ANN (LPC, MED)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WOODRUFF RD STE 450
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3443
Mailing Address - Country:US
Mailing Address - Phone:864-400-5130
Mailing Address - Fax:864-818-4697
Practice Address - Street 1:430 WOODRUFF RD STE 450
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3443
Practice Address - Country:US
Practice Address - Phone:864-400-5130
Practice Address - Fax:864-818-4697
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5634101YP2500X
SC6393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional