Provider Demographics
NPI:1790106466
Name:ROEHRIG, HEIDI (LMHC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:ROEHRIG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0411
Mailing Address - Country:US
Mailing Address - Phone:904-910-6174
Mailing Address - Fax:
Practice Address - Street 1:9471 BAYMEADOWS RD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7936
Practice Address - Country:US
Practice Address - Phone:904-503-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-8199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health