Provider Demographics
NPI:1366250581
Name:HATOUM, HEBA (LCSW)
Entity type:Individual
Prefix:
First Name:HEBA
Middle Name:
Last Name:HATOUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1104
Mailing Address - Country:US
Mailing Address - Phone:804-982-0060
Mailing Address - Fax:
Practice Address - Street 1:1012 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1104
Practice Address - Country:US
Practice Address - Phone:804-982-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09040153201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical