Provider Demographics
NPI:1790382414
Name:HEAP, PATRICK C (LMHC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:C
Last Name:HEAP
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2707
Mailing Address - Country:US
Mailing Address - Phone:401-406-9266
Mailing Address - Fax:
Practice Address - Street 1:75 LAMBERT LIND HWY STE 120
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1163
Practice Address - Country:US
Practice Address - Phone:401-681-4274
Practice Address - Fax:401-681-4285
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health