Provider Demographics
NPI:1487009262
Name:HEARD, KORINA (BSW)
Entity Type:Individual
Prefix:
First Name:KORINA
Middle Name:
Last Name:HEARD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SW CAMPUS DR APT 10-201
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-8381
Mailing Address - Country:US
Mailing Address - Phone:206-321-7859
Mailing Address - Fax:
Practice Address - Street 1:1100 DEXTER AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3598
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:722-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health