Organization
CAROLYN J HEINEMAN PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN J HEINEMAN (PRESIDENT)
(269) 345-7101
Entity
Organization
Contact information
Practice address
5228 LOVERS LN, SUITE 104, PORTAGE, MI 49002-1521
(269) 345-7101
(269) 345-7101
Mailing address
5228 LOVERS LN, SUITE 104, PORTAGE, MI 49002-1521
(269) 345-7101
(269) 345-7101
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301013201
MI
Other
Enumeration date
04/28/2011
Last updated
04/28/2011
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