Provider Demographics
NPI:1730212812
Name:HEFLIN, SAM JAMES (MSW)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:JAMES
Last Name:HEFLIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2007
Mailing Address - Country:US
Mailing Address - Phone:304-425-6399
Mailing Address - Fax:
Practice Address - Street 1:905 MERCER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2909
Practice Address - Country:US
Practice Address - Phone:304-425-5653
Practice Address - Fax:304-425-2837
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00802651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical