Provider Demographics
NPI:1962291393
Name:HEATH, TARA LEIGH (LCMHCA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:HEATH
Suffix:
Gender:
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 BEDGOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8515
Mailing Address - Country:US
Mailing Address - Phone:252-265-9200
Mailing Address - Fax:252-237-8600
Practice Address - Street 1:2416 BEDGOOD DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8515
Practice Address - Country:US
Practice Address - Phone:252-265-9200
Practice Address - Fax:252-237-8600
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health