Healthcare Provider Details

I. General information

NPI: 1124005194
Provider Name (Legal Business Name): LOUIS HEYWARD SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STERNBERG AVENUE BUILDING 515
FORT EUSTIS VA
23604
US

IV. Provider business mailing address

4 BLACK OAK CT
HAMPTON VA
23666-1800
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7910
  • Fax: 757-314-7576
Mailing address:
  • Phone: 757-826-1263
  • Fax: 757-314-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: