Healthcare Provider Details

I. General information

NPI: 1689564759
Provider Name (Legal Business Name): HEATHER HEADLEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LIBBIE AVE STE 104
RICHMOND VA
23226-2658
US

IV. Provider business mailing address

412 LIBBIE AVE STE 104
RICHMOND VA
23226-2658
US

V. Phone/Fax

Practice location:
  • Phone: 804-314-5416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810008080
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: