Provider Demographics
NPI:1730933268
Name:HEAVIN, TIMOTHY (CHW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:HEAVIN
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 VALLEY VIEW RD APT 18
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5850
Mailing Address - Country:US
Mailing Address - Phone:831-901-1328
Mailing Address - Fax:
Practice Address - Street 1:1560 VALLEY VIEW RD APT 18
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5850
Practice Address - Country:US
Practice Address - Phone:831-901-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No251K00000XAgenciesPublic Health or Welfare
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner