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General NPI Number Information
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NPI Number | 1366751273
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Entity Type | Individual
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Provider Name | HEATHER RUNYON LPC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 2120 NORTHGATE PARK LN SUITE 201
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City | CHATTANOOGA
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State | TN
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Zip | 37415-6937
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Country | US
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Telephone | 423-870-5647
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Fax | 423-870-5545
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Provider Business Mailing Address
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Address Line | 2120 NORTHGATE PARK LN SUITE 201
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City | CHATTANOOGA
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State | TN
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Zip | 37415-6937
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Country | US
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Telephone | 423-870-5647
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Fax | 423-870-5545
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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 | LPC005002
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 2850
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License Number State | TN
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