Provider Demographics
NPI:1942046230
Name:HEYEN, CHRISTINE (LAC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:HEYEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 N 400 E
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-8235
Mailing Address - Country:US
Mailing Address - Phone:765-505-8824
Mailing Address - Fax:
Practice Address - Street 1:3206 N 400 E
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-8235
Practice Address - Country:US
Practice Address - Phone:765-505-8824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000452A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)