Provider Demographics
NPI:1891980363
Name:HECKEL-MUNC, MOLLIE (PHD)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:HECKEL-MUNC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:HECKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1212 COLLEGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3977
Mailing Address - Country:US
Mailing Address - Phone:707-210-5350
Mailing Address - Fax:707-843-5095
Practice Address - Street 1:1212 COLLEGE AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3977
Practice Address - Country:US
Practice Address - Phone:707-210-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
CAPSY26757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor