Provider Demographics
NPI:1023397742
Name:FICKENWORTH, HEATHER CHRISTINE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:FICKENWORTH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1952
Mailing Address - Country:US
Mailing Address - Phone:814-835-1700
Mailing Address - Fax:
Practice Address - Street 1:2170 W 32ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1952
Practice Address - Country:US
Practice Address - Phone:814-835-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005980101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health