=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750156832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINNI LYNNE HEFNER LCSWA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2023
-----------------------------------------------------
Last Update Date | 11/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 18TH ST SE
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28602-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-322-6633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1508 RUNNING DEER DR NW
-----------------------------------------------------
City | CONOVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28613-8039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-485-7073
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P019976
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------