Healthcare Provider Details

I. General information

NPI: 1497667257
Provider Name (Legal Business Name): HEATHER BETH AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 RIXLEW LN STE 401
MANASSAS VA
20109-4277
US

IV. Provider business mailing address

11700 WISTERIA POND WAY APT 202
MANASSAS VA
20109-3829
US

V. Phone/Fax

Practice location:
  • Phone: 571-424-1764
  • Fax: 703-520-7738
Mailing address:
  • Phone: 703-872-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004669
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906016647
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: