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General NPI Number Information
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NPI Number | 1295842060
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Entity Type | Individual
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Provider Name | HEIKE M MINNICH PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 701 GROVE RD SUITE 200
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City | GREENVILLE
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State | SC
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Zip | 29605-4210
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Country | US
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Telephone | 864-455-8431
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Fax | 864-455-8981
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE PT SUITE 212
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City | GREENVILLE
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State | SC
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Zip | 29615-4545
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Country | US
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Telephone | 864-797-6044
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Fax | 864-797-6198
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 20041855
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1306
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License Number State | SC
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