Healthcare Provider Details

I. General information

NPI: 1134454556
Provider Name (Legal Business Name): ALEXIS G HEITMAN LMHC, LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2009
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705A OLD POST RD
CHARLESTOWN RI
02813-1819
US

IV. Provider business mailing address

4705A OLD POST RD
CHARLESTOWN RI
02813-1819
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-7705
  • Fax: 401-364-9104
Mailing address:
  • Phone: 401-364-7705
  • Fax: 401-364-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00470
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00431
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: