Carol Sue Heavin, LAC, TA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A1707234 Issued in AR

Practice address

10500 Woodman St
Mabelvale, AR 72103-1789

Phone

(501) 247-1456

NPI assigned

Oct 25, 2019

Last updated

Oct 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: carol.heavin@counselingsecure.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1154964872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 HEINKE RD",
            "city": "MABELVALE",
            "state": "AR",
            "postal_code": "721032048",
            "telephone_number": "501-455-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10500 WOODMAN ST",
            "city": "MABELVALE",
            "state": "AR",
            "postal_code": "721031789",
            "telephone_number": "501-247-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEAVIN",
        "first_name": "CAROL",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "LAC, TA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-25",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A1707234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carol.heavin@counselingsecure.com",
            "affiliation": "N",
            "address_1": "10500 Woodman St",
            "city": "Mabelvale",
            "state": "AR",
            "country_code": "US",
            "postal_code": "721031789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Mabelvale, AR
• Providers in Mabelvale, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.