Provider Demographics
NPI:1861626905
Name:HEREDIA, DEBBI M (B S)
Entity Type:Individual
Prefix:
First Name:DEBBI
Middle Name:M
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:B S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15408
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-5408
Mailing Address - Country:US
Mailing Address - Phone:805-540-6500
Mailing Address - Fax:805-540-6501
Practice Address - Street 1:784 HIGH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5243
Practice Address - Country:US
Practice Address - Phone:805-540-6500
Practice Address - Fax:805-540-6501
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health