Provider Demographics
NPI:1740427020
Name:BOAN, HEATHER VINSON
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:VINSON
Last Name:BOAN
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 1:310 NW BACKWOODS RD
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8668
Mailing Address - Country:US
Mailing Address - Phone:252-232-4049
Mailing Address - Fax:252-232-4049
Practice Address - Street 1:310 NW BACKWOODS RD
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8668
Practice Address - Country:US
Practice Address - Phone:252-232-4049
Practice Address - Fax:252-232-4049
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252Y00000X
NC00005101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool