Provider Demographics
NPI:1386492163
Name:CORMIER, HEATHER (RBT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CORMIER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 BRIDGEMAN LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5419
Mailing Address - Country:US
Mailing Address - Phone:585-329-6325
Mailing Address - Fax:
Practice Address - Street 1:732 EDEN WAY N STE E563
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2798
Practice Address - Country:US
Practice Address - Phone:540-915-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician