Healthcare Provider Details

I. General information

NPI: 1942479340
Provider Name (Legal Business Name): PATRICK TERRENCE HEFFERAN M.ED., NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 09/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LAKE BOONE TRL SUITE 300
RALEIGH NC
27607-2934
US

IV. Provider business mailing address

3801 LAKE BOONE TRL SUITE 300
RALEIGH NC
27607-2934
US

V. Phone/Fax

Practice location:
  • Phone: 919-616-6779
  • Fax: 919-784-9184
Mailing address:
  • Phone: 919-616-6779
  • Fax: 919-784-9184

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: