Provider Demographics
NPI:1417004052
Name:DALTON, HEIDRUN M
Entity Type:Individual
Prefix:MS
First Name:HEIDRUN
Middle Name:M
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG-HEIDELBERG
Mailing Address - Street 2:IMEU-HEI-HRA UNIT 2937
Mailing Address - City:HEIDELBERG
Mailing Address - State:BADEN WURTEMBERG
Mailing Address - Zip Code:APO AE 09102
Mailing Address - Country:DE
Mailing Address - Phone:0622-157-7475
Mailing Address - Fax:0622-157-5265
Practice Address - Street 1:USAG DARMSTADT
Practice Address - Street 2:UNIT 29500 BOX 31
Practice Address - City:DARMSTADT
Practice Address - State:HESSEN
Practice Address - Zip Code:APO AE 09175
Practice Address - Country:DE
Practice Address - Phone:0615-169-1710
Practice Address - Fax:0615-169-7579
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4106101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)