Provider Demographics
NPI:1699934364
Name:HESELTON, JOSHUA ALAN (LICSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALAN
Last Name:HESELTON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:ALAN
Other - Last Name:HESELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:750 MORPHY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1812
Mailing Address - Country:US
Mailing Address - Phone:251-279-1119
Mailing Address - Fax:251-279-1117
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-279-1119
Practice Address - Fax:251-279-1117
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060055811041C0700X
AL2445C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical