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General NPI Number Information
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NPI Number | 1467003715
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Entity Type | Individual
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Provider Name | KELLY DENEEN HEINZMAN MED LPC LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 1101 WILSON BLVD
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City | ARLINGTON
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State | VA
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Zip | 22209-2211
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Country | US
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Telephone | 703-625-4182
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 36TH RD N
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City | ARLINGTON
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State | VA
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Zip | 22207-4817
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Country | US
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Telephone | 703-625-4182
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 0701001713
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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 | 0717000464
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License Number State | VA
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