Provider Demographics
NPI:1467405530
Name:HEINRICH, WILLA JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:WILLA
Middle Name:JEAN
Last Name:HEINRICH
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 1:688 WILLOUGHBY WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1113
Mailing Address - Country:US
Mailing Address - Phone:404-659-5945
Mailing Address - Fax:
Practice Address - Street 1:688 WILLOUGHBY WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1113
Practice Address - Country:US
Practice Address - Phone:404-659-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical