Provider Demographics
NPI:1144061698
Name:DUCKETT, HEATHER NICOLE (MS, MFT-I)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:MS, MFT-I
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:VISAGE/HARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2292 CHAMBLISS AVE NW STE C-2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3862
Mailing Address - Country:US
Mailing Address - Phone:423-479-5672
Mailing Address - Fax:
Practice Address - Street 1:2292 CHAMBLISS AVE NW STE C-2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3862
Practice Address - Country:US
Practice Address - Phone:423-479-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist