Provider Demographics
NPI:1730932542
Name:SHOCKLEY, HEATHER M (MA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:DABATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4595 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2058
Mailing Address - Country:US
Mailing Address - Phone:904-448-4700
Mailing Address - Fax:904-783-1901
Practice Address - Street 1:4595 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2058
Practice Address - Country:US
Practice Address - Phone:904-448-4700
Practice Address - Fax:904-783-1901
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health