Healthcare Provider Details

I. General information

NPI: 1790049187
Provider Name (Legal Business Name): HEIDI KATHRYN VANCE LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 PURDUE DR SUITE 200
FAYETTEVILLE NC
28303-5509
US

IV. Provider business mailing address

1540 PURDUE DR SUITE 200
FAYETTEVILLE NC
28303-5509
US

V. Phone/Fax

Practice location:
  • Phone: 910-867-8889
  • Fax:
Mailing address:
  • Phone: 910-867-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA9230
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: