Healthcare Provider Details

I. General information

NPI: 1710709985
Provider Name (Legal Business Name): JEFFREY HEFLIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20029 MILL POINT ROAD
BOONSBORO MD
21713
US

IV. Provider business mailing address

20029 MIL POINT ROAD
BOONSBOROR MD
21713
US

V. Phone/Fax

Practice location:
  • Phone: 301-401-1438
  • Fax:
Mailing address:
  • Phone: 301-401-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: