Healthcare Provider Details

I. General information

NPI: 1114567799
Provider Name (Legal Business Name): HEATHER LYNN BROSTRAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY BLDG 253
NAPA CA
94558-6234
US

IV. Provider business mailing address

1244 ROLLING HILL CT
MARTINEZ CA
94553-4856
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-8001
  • Fax:
Mailing address:
  • Phone: 925-324-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: