Provider Demographics
NPI:1487061990
Name:HEATWOLE, ROXANNE (LCSW, CCDP-D)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:HEATWOLE
Suffix:
Gender:F
Credentials:LCSW, CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1242
Mailing Address - Country:US
Mailing Address - Phone:302-856-9746
Mailing Address - Fax:302-856-9766
Practice Address - Street 1:10 N RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1242
Practice Address - Country:US
Practice Address - Phone:302-856-9746
Practice Address - Fax:302-856-9766
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00012821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical