Individual
HEIDI LANO LICUDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 VIRGINIA BEACH BLVD STE 117, VIRGINIA BEACH, VA 23452-1759
(855) 832-6727
(772) 675-9100
Mailing address
667 ANNAKA LOOP, CHESAPEAKE, VA 23323-2111
(757) 403-6697
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0134000621
VA
Other
Enumeration date
06/27/2019
Last updated
09/18/2025
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