MEDICARE: LORNA THERESE VANDEN HEUVEL LCAS, LCSWA, CSI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P016123	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	P016123	NC

General Provider Information

NPI Number	:	1770155004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORNA THERESE VANDEN HEUVEL LCAS, LCSWA, CSI

Provider Business Mailing Address
First Line	:	3140 RETAMA RUN
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-9345
Country	:	US
Telephone Number	:	919-523-7881
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 RETAMA RUN
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-9345
Country	:	US
Telephone Number	:	919-523-7881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	05/03/2022

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