Healthcare Provider Details

I. General information

NPI: 1295464204
Provider Name (Legal Business Name): ABIGAIL HEITER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIGAIL STARNS LCSW

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 NUCKOLS RD STE 102
GLEN ALLEN VA
23059-2558
US

IV. Provider business mailing address

6603 IRONGATE SQ
NORTH CHESTERFIELD VA
23234-6081
US

V. Phone/Fax

Practice location:
  • Phone: 434-953-3664
  • Fax:
Mailing address:
  • Phone: 804-743-0960
  • Fax: 804-396-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: