Provider Demographics
NPI:1942507561
Name:VAN HEERDEN, CARLA LAUREN
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:LAUREN
Last Name:VAN HEERDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 W BANBURY DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2410
Mailing Address - Country:US
Mailing Address - Phone:253-651-8044
Mailing Address - Fax:
Practice Address - Street 1:1004 W BANBURY DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2410
Practice Address - Country:US
Practice Address - Phone:253-651-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health