MEDICARE: CHRISTINE MARIE HEINRICHS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	7322	NC

General Provider Information

NPI Number	:	1679717011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIE HEINRICHS LPC

Provider Business Mailing Address
First Line	:	10707 PENDRAGON PL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8993
Country	:	US
Telephone Number	:	919-633-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	8390 SIX FORKS RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-3060
Country	:	US
Telephone Number	:	919-782-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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