Provider Demographics
NPI:1699329292
Name:BEDFORD, HEATHER LEIGH (MA, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:BEDFORD
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5816
Mailing Address - Country:US
Mailing Address - Phone:803-731-4708
Mailing Address - Fax:
Practice Address - Street 1:900 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5816
Practice Address - Country:US
Practice Address - Phone:803-731-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor