Doctor Name: | DR. MARK MICHAEL HEYNE |
NPI Number: | 1053628321 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PSY 25610 |
Business Practice Address: | 9300 Dewitt Loop Fort Belvoir, VA - 220605285 |
Business Phone Number: | 5712314667 |
Business Fax Number: | |
Mailing Address: | 6900 Andover Dr, ALEXANDRIA |
State: | VA |
Postal Code: | 223071701 |
Phone Number: | 7733830068 |
Fax Number: | |
NPI Enumeration Date: | 09/08/2010 |
NPI Last Update Date: | 10/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY 25610 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |