Provider Demographics
NPI:1194053116
Name:HETRICK, LLUVIA
Entity type:Individual
Prefix:
First Name:LLUVIA
Middle Name:
Last Name:HETRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 MEADOW OAK WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3463
Mailing Address - Country:US
Mailing Address - Phone:530-604-0453
Mailing Address - Fax:
Practice Address - Street 1:2295 HILLTOP DR STE 3
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0515
Practice Address - Country:US
Practice Address - Phone:530-604-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103371106H00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker