Provider Demographics
NPI:1225446008
Name:HECKMAN, BERNADETTE (PHD)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 OAKLAKE TRL
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5967
Mailing Address - Country:US
Mailing Address - Phone:740-707-6130
Mailing Address - Fax:
Practice Address - Street 1:1160 S MILLEDGE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1350
Practice Address - Country:US
Practice Address - Phone:740-707-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical