Provider Demographics
NPI:1659689057
Name:BLOCK, HEATHER (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 KENTUCKY AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1447
Mailing Address - Country:US
Mailing Address - Phone:202-531-3193
Mailing Address - Fax:
Practice Address - Street 1:121 KENTUCKY AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1447
Practice Address - Country:US
Practice Address - Phone:202-531-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01842171100000X
DCAC500135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist