Provider Demographics
NPI:1740709435
Name:HEARP, CARESSA BAMBI I
Entity type:Individual
Prefix:
First Name:CARESSA
Middle Name:BAMBI
Last Name:HEARP
Suffix:I
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 1:707 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5054
Mailing Address - Country:US
Mailing Address - Phone:707-975-5279
Mailing Address - Fax:
Practice Address - Street 1:2300 NORTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5004
Practice Address - Country:US
Practice Address - Phone:707-571-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health