Healthcare Provider Details

I. General information

NPI: 1689979494
Provider Name (Legal Business Name): HEATHER HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 MYTERRA WAY
OAK HILL VA
20171-2113
US

IV. Provider business mailing address

12319 MYTERRA WAY
OAK HILL VA
20171-2113
US

V. Phone/Fax

Practice location:
  • Phone: 703-307-1619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: