Provider Demographics
NPI:1285947770
Name:HOLLEMAN, HEATHER (PHD, HSPP)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:HOLLEMAN
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3028
Mailing Address - Country:US
Mailing Address - Phone:574-339-4832
Mailing Address - Fax:574-222-2468
Practice Address - Street 1:3220 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3028
Practice Address - Country:US
Practice Address - Phone:574-339-4832
Practice Address - Fax:574-222-2468
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042587A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical