Healthcare Provider Details

I. General information

NPI: 1235830548
Provider Name (Legal Business Name): HEATHER VENTURA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 CROSS LANES DR
CROSS LANES WV
25313-1338
US

IV. Provider business mailing address

42 BEAVER DR
HURRICANE WV
25526-9396
US

V. Phone/Fax

Practice location:
  • Phone: 304-784-3961
  • Fax:
Mailing address:
  • Phone: 304-784-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW082216329
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: