Healthcare Provider Details

I. General information

NPI: 1992867196
Provider Name (Legal Business Name): RANDI HEPNER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SERENO DRIVE
VALLEJO CA
94589-1003
US

IV. Provider business mailing address

800 SERENO DR
VALLEJO CA
94589-1003
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2629
  • Fax:
Mailing address:
  • Phone: 707-651-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC27234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: