Healthcare Provider Details

I. General information

NPI: 1821708777
Provider Name (Legal Business Name): ABIGAIL HEIT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21561 WELBY TER
BROADLANDS VA
20148-5049
US

IV. Provider business mailing address

21561 WELBY TER
BROADLANDS VA
20148-5049
US

V. Phone/Fax

Practice location:
  • Phone: 224-628-6109
  • Fax:
Mailing address:
  • Phone: 224-628-6109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL HEIT
Title or Position: OWNER
Credential: LCSW
Phone: 224-628-6109