Provider Demographics
NPI:1841775384
Name:HEFLIN, KIM CASSANDRA (CDCA LLL)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CASSANDRA
Last Name:HEFLIN
Suffix:
Gender:F
Credentials:CDCA LLL
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:CASSANDRA
Other - Last Name:HEFLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA LLL
Mailing Address - Street 1:1 ELIZABETH PL STE 1170
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1122
Practice Address - Country:US
Practice Address - Phone:937-496-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141607101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139823Medicaid