Provider Demographics
NPI:1871783118
Name:HEATH, JUDY (LISW, MSW)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7170
Mailing Address - Country:US
Mailing Address - Phone:843-225-1244
Mailing Address - Fax:843-795-1002
Practice Address - Street 1:628 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7170
Practice Address - Country:US
Practice Address - Phone:843-225-1244
Practice Address - Fax:843-795-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical