Provider Demographics
NPI:1932766136
Name:HEFFRON, CHRISTINE SUE (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SUE
Last Name:HEFFRON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58295 KRISTINA CIR W
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8605
Mailing Address - Country:US
Mailing Address - Phone:269-929-0210
Mailing Address - Fax:
Practice Address - Street 1:5360 HOLIDAY TER STE 32
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2126
Practice Address - Country:US
Practice Address - Phone:269-251-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010934791041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical