Provider Demographics
NPI:1770184657
Name:HEARON, DELIA (LCSW OR LICSW PIP)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:HEARON
Suffix:
Gender:F
Credentials:LCSW OR LICSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE CIRCLE WAY APT 216
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6131
Mailing Address - Country:US
Mailing Address - Phone:360-813-5623
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE CIRCLE WAY APT 216
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6131
Practice Address - Country:US
Practice Address - Phone:360-813-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0134551041C0700X
AL1630-4514C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty