Healthcare Provider Details

I. General information

NPI: 1770463929
Provider Name (Legal Business Name): HEOREON AN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUSTINE AN

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 10/24/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 WALNUT ST # 202
PHILADELPHIA PA
19102-3001
US

IV. Provider business mailing address

2011 KIMBALL ST
PHILADELPHIA PA
19146-2622
US

V. Phone/Fax

Practice location:
  • Phone: 215-642-8968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC019041
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: