Provider Demographics
NPI:1942923552
Name:HEATH, ERIN (MFA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4348 BROADWAY APT C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4602
Mailing Address - Country:US
Mailing Address - Phone:802-989-3736
Mailing Address - Fax:
Practice Address - Street 1:4348 BROADWAY APT C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4602
Practice Address - Country:US
Practice Address - Phone:802-989-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health