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General NPI Number Information
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NPI Number | 1346482924
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Entity Type | Individual
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Provider Name | THOMAS LEE HEASLEY LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 2727 ELECTRIC RD STE 103
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City | ROANOKE
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State | VA
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Zip | 24018-3500
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Country | US
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Telephone | 540-355-8626
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Fax | 540-283-0769
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Provider Business Mailing Address
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Address Line | PO BOX 21701
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City | ROANOKE
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State | VA
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Zip | 24018-0172
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Country | US
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Telephone | 540-355-8626
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Fax | 540-283-0769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005051
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001182
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License Number State | VA
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