Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C005317 | NC |
NPI | 1003051590 |
---|---|
Provider Name | Mrs. Amy Dawn Heinz |
First Address | Camp Lejeune, NC 28542 |
Second Address | Camp Lejeune, NC 28542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 21/09/2020 |