Provider Demographics
NPI:1316215767
Name:HEINZ, JOANNA DANNER (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:DANNER
Last Name:HEINZ
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:MISS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:DANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 GINA MARIE LN
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9448
Mailing Address - Country:US
Mailing Address - Phone:231-409-0025
Mailing Address - Fax:
Practice Address - Street 1:1000 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3445
Practice Address - Country:US
Practice Address - Phone:231-947-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional