Provider Demographics
NPI:1366566242
Name:HEACOX-WINBORN, RENEE CHRISTINE (LISW)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:CHRISTINE
Last Name:HEACOX-WINBORN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:CHRISTINE
Other - Last Name:HEACOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:222 S TIN ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-3645
Mailing Address - Country:US
Mailing Address - Phone:575-694-5478
Mailing Address - Fax:
Practice Address - Street 1:415 W HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3622
Practice Address - Country:US
Practice Address - Phone:575-694-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-069001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical