Provider Demographics
NPI:1861962870
Name:HECKENLIVELY, DAVID R JR (MFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HECKENLIVELY
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NORWICH PL
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1522
Mailing Address - Country:US
Mailing Address - Phone:925-788-4541
Mailing Address - Fax:
Practice Address - Street 1:33 QUAIL CT STE 103
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5564
Practice Address - Country:US
Practice Address - Phone:925-788-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38744101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor