Provider Demographics
NPI:1770080988
Name:HEATH, CROY LARNELL
Entity type:Individual
Prefix:
First Name:CROY
Middle Name:LARNELL
Last Name:HEATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WAINWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-3467
Mailing Address - Country:US
Mailing Address - Phone:256-438-6928
Mailing Address - Fax:
Practice Address - Street 1:116 CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6287
Practice Address - Country:US
Practice Address - Phone:256-459-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health