Provider Demographics
NPI:1427372119
Name:HEINSZ, SANDRA V (PHD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:V
Last Name:HEINSZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 ASHBOROUGH PARK
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6514
Mailing Address - Country:US
Mailing Address - Phone:404-455-5959
Mailing Address - Fax:678-228-1826
Practice Address - Street 1:290 ASHBOROUGH PARK
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6514
Practice Address - Country:US
Practice Address - Phone:404-455-5959
Practice Address - Fax:678-228-1826
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical