Provider Demographics
NPI:1871091892
Name:HEIM, CRENGUTA RALUCA
Entity type:Individual
Prefix:
First Name:CRENGUTA
Middle Name:RALUCA
Last Name:HEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 W WARM SPRINGS RD UNIT 1121
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-5526
Mailing Address - Country:US
Mailing Address - Phone:702-372-8750
Mailing Address - Fax:
Practice Address - Street 1:2050 W WARM SPRINGS RD UNIT 1121
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-5526
Practice Address - Country:US
Practice Address - Phone:702-372-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02455-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)