Healthcare Provider Details

I. General information

NPI: 1447936711
Provider Name (Legal Business Name): DAYANARA HEATON CO61448650
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LAKEWAY DR
BELLINGHAM WA
98225-5233
US

IV. Provider business mailing address

515 LAKEWAY DR
BELLINGHAM WA
98225-5233
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-2187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61448650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: