Healthcare Provider Details

I. General information

NPI: 1942892054
Provider Name (Legal Business Name): KELLY SNOW-HEINZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N HILL DR
WARRENTON VA
20186-2610
US

IV. Provider business mailing address

6923 EMMA CT
WARRENTON VA
20187-8963
US

V. Phone/Fax

Practice location:
  • Phone: 540-347-7620
  • Fax:
Mailing address:
  • Phone: 540-229-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: