Healthcare Provider Details

I. General information

NPI: 1811018500
Provider Name (Legal Business Name): ROSE ANN HEFNER LPC , LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 LEON SULLIVAN WAY STE. 300
CHARLESTON WV
25301-2402
US

IV. Provider business mailing address

16 LEON SULLIVAN WAY STE. 300
CHARLESTON WV
25301-2402
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-9689
  • Fax: 304-345-4601
Mailing address:
  • Phone: 304-346-9689
  • Fax: 304-345-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1547
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1547
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1547
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1547
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1547
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00941696
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: