MEDICARE: LAUREN ROSE HETZLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1598438897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ROSE HETZLER LCSW

Provider Business Mailing Address
First Line	:	84 SOUTHGATE SQ # 1144
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3611
Country	:	US
Telephone Number	:	804-638-9902
Fax Number	:

Provider Business Practice Location Address
First Line	:	18701 CHURCH RD
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23803-1339
Country	:	US
Telephone Number	:	804-638-9902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2021
Last Update Date	:	02/05/2026

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