Healthcare Provider Details

I. General information

NPI: 1972802585
Provider Name (Legal Business Name): HEATHER ELIZABETH EVANS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CUMBERLAND ROAD
CEDAR BLUFF VA
24609-0810
US

IV. Provider business mailing address

PO BOX 810
CEDAR BLUFF VA
24609-0810
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-6702
  • Fax: 276-964-0292
Mailing address:
  • Phone: 276-964-6702
  • Fax: 276-964-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004994
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: