Healthcare Provider Details

I. General information

NPI: 1518492883
Provider Name (Legal Business Name): ANGELA DENISE HEGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ANGELA DENISE CULLINS

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 W MOCKINGBIRD LN STE 4000
DALLAS TX
75235-5014
US

IV. Provider business mailing address

1545 W MOCKINGBIRD LN STE 4000
DALLAS TX
75235-5014
US

V. Phone/Fax

Practice location:
  • Phone: 214-821-6505
  • Fax:
Mailing address:
  • Phone: 214-821-6505
  • 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: