Provider Demographics
NPI:1588221675
Name:HEARD, VIRGINIA R
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:R
Last Name:HEARD
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:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:GOLCONDA
Mailing Address - State:NV
Mailing Address - Zip Code:89414-0042
Mailing Address - Country:US
Mailing Address - Phone:541-561-1093
Mailing Address - Fax:
Practice Address - Street 1:425 OLD HIGHWAY 40 E
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:NV
Practice Address - Zip Code:89414-8941
Practice Address - Country:US
Practice Address - Phone:541-561-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician