Provider Demographics
NPI:1316623580
Name:GREGORY, HEIDI C (CADACII)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:C
Last Name:GREGORY
Suffix:
Gender:F
Credentials:CADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STATE ROAD 28 E
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:IN
Mailing Address - Zip Code:47981-9604
Mailing Address - Country:US
Mailing Address - Phone:765-418-5306
Mailing Address - Fax:
Practice Address - Street 1:105 STATE ROAD 28 E
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:IN
Practice Address - Zip Code:47981-9604
Practice Address - Country:US
Practice Address - Phone:765-418-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
INC-51219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)