Provider Demographics
NPI:1538826524
Name:HIEBERT, LORI ANN (MA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:HIEBERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:SMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4010 NEWBERRY RD STE F
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2368
Mailing Address - Country:US
Mailing Address - Phone:352-373-1218
Mailing Address - Fax:
Practice Address - Street 1:4010 NEWBERRY RD STE F
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2368
Practice Address - Country:US
Practice Address - Phone:352-373-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health