| Doctor Name: | MICHELLE JACKSON HEINS |
| NPI Number: | 1144544420 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.A. |
| License Number: | |
| Business Practice Address: | 316 Station St Bridgeville, PA - 150171833 |
| Business Phone Number: | 4122211091 |
| Business Fax Number: | 4122211091 |
| Mailing Address: | 316 Station St, BRIDGEVILLE |
| State: | PA |
| Postal Code: | 150171833 |
| Phone Number: | 4122211091 |
| Fax Number: | 4122211091 |
| NPI Enumeration Date: | 03/16/2010 |
| NPI Last Update Date: | 03/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |