Provider Demographics
NPI:1699426528
Name:HEJAZI, VIDA
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:HEJAZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 S HOLLY PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7011
Mailing Address - Country:US
Mailing Address - Phone:720-556-5163
Mailing Address - Fax:
Practice Address - Street 1:3052 S HOLLY PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7011
Practice Address - Country:US
Practice Address - Phone:720-556-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor