Provider Demographics
NPI:1811557739
Name:DUNIVON, HEATHER A (LLPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:DUNIVON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1305
Mailing Address - Country:US
Mailing Address - Phone:616-366-5363
Mailing Address - Fax:
Practice Address - Street 1:3899 OKEMOS RD STE A1
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3666
Practice Address - Country:US
Practice Address - Phone:517-507-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health