Provider Demographics
NPI:1699442764
Name:HEATHER SURBER LICSW LLC
Entity type:Organization
Organization Name:HEATHER SURBER LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SURBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-542-3288
Mailing Address - Street 1:9238 MADISON BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9112
Mailing Address - Country:US
Mailing Address - Phone:256-542-3288
Mailing Address - Fax:256-542-3289
Practice Address - Street 1:9238 MADISON BLVD STE 116
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9112
Practice Address - Country:US
Practice Address - Phone:256-542-3288
Practice Address - Fax:256-542-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health