Provider Demographics
NPI:1699540088
Name:SEALS, HEATHER GRACE (MA, LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:GRACE
Last Name:SEALS
Suffix:
Gender:M
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9154
Mailing Address - Country:US
Mailing Address - Phone:517-414-0168
Mailing Address - Fax:
Practice Address - Street 1:3213 DILLON RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9154
Practice Address - Country:US
Practice Address - Phone:517-414-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health