Provider Demographics
NPI:1013405364
Name:UNTERBERG, HEIDI FAITH (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:FAITH
Last Name:UNTERBERG
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2060
Mailing Address - Country:US
Mailing Address - Phone:570-994-2664
Mailing Address - Fax:570-694-6694
Practice Address - Street 1:745 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-994-2664
Practice Address - Fax:570-694-6694
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor