| Carolyn J Heineman Phd Llc | |
|
5228 Lovers Ln Suite 104 Portage MI 49002-1521 | |
| (269) 345-7101 | |
| (269) 345-7101 |
| Full Name | Carolyn J Heineman Phd Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 5228 Lovers Ln, Portage, Michigan |
| Authorized Official Name and Position | Carolyn J Heineman (PRESIDENT) |
| Authorized Official Contact | 2693457101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolyn J Heineman Phd Llc 5228 Lovers Ln Suite 104 Portage MI 49002-1521 Ph: (269) 345-7101 | Carolyn J Heineman Phd Llc 5228 Lovers Ln Suite 104 Portage MI 49002-1521 Ph: (269) 345-7101 |
| NPI Number | 1689965329 |
|---|---|
| Provider Enumeration Date | 04/28/2011 |
| Last Update Date | 04/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689965329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301013201 (Michigan) | Primary |
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