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General NPI Number Information
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NPI Number | 1194563858
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Entity Type | Individual
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Provider Name | HEIDI JENNIFER HEDRICK
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Gender | Female
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Dates
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Enumeration Date | 07/17/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-3003
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Country | US
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Telephone | 352-265-7981
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Fax |
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Provider Business Mailing Address
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Address Line | 8763 SW 27T LN #101
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City | GAINESVILE
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State | FL
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Zip | 32608
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Country | US
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Telephone | 352-265-7810
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Fax | 352-627-4889
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH23854
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH23854
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License Number State | FL
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