Provider Demographics
NPI:1962572966
Name:HEIM, STEPHEN VINCENT (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VINCENT
Last Name:HEIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SOUTH ST
Mailing Address - Street 2:STE. 5
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5215
Mailing Address - Country:US
Mailing Address - Phone:434-971-4747
Mailing Address - Fax:434-293-4690
Practice Address - Street 1:100 E SOUTH ST
Practice Address - Street 2:STE. 5
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5215
Practice Address - Country:US
Practice Address - Phone:434-971-4747
Practice Address - Fax:434-293-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA775843Medicaid