Provider Demographics
NPI:1538413190
Name:HEATHERS, SHERLE LEE (LMSW)
Entity type:Individual
Prefix:
First Name:SHERLE
Middle Name:LEE
Last Name:HEATHERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252
Mailing Address - Country:US
Mailing Address - Phone:207-319-2320
Mailing Address - Fax:
Practice Address - Street 1:645 BOUROUGHS RD
Practice Address - Street 2:
Practice Address - City:BOWDOIN
Practice Address - State:ME
Practice Address - Zip Code:04525
Practice Address - Country:US
Practice Address - Phone:207-319-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELM120811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical