Provider Demographics
NPI:1154150647
Name:HEYWARD, BERNARD LAMONT
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:LAMONT
Last Name:HEYWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 FOX TROTTER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2349
Mailing Address - Country:US
Mailing Address - Phone:804-317-7777
Mailing Address - Fax:
Practice Address - Street 1:4324 FOX TROTTER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2349
Practice Address - Country:US
Practice Address - Phone:804-317-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704005770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional