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General NPI Number Information
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NPI Number | 1629336003
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Entity Type | Individual
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Provider Name | RICHARD AUSTIN HEAFEY
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Gender | Male
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 13666 E 14TH ST
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2538
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Country | US
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Telephone | 202-615-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 226 RITCH ST UNIT 302
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-1782
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Country | US
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Telephone | 202-615-0711
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Fax |
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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 |
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License Number State |
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