Healthcare Provider Details

I. General information

NPI: 1265195341
Provider Name (Legal Business Name): VIOLA HEGGS LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N WASHINGTON ST APT B
HAMMONTON NJ
08037-1536
US

IV. Provider business mailing address

220 N WASHINGTON ST APT B
HAMMONTON NJ
08037-1536
US

V. Phone/Fax

Practice location:
  • Phone: 856-434-2490
  • Fax:
Mailing address:
  • Phone: 856-434-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00317400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: