Provider Demographics
NPI:1033898218
Name:GEOGHEGAN, HEATHER ADAIR (LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ADAIR
Last Name:GEOGHEGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 N CROATAN HWY UNIT 27
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-6962
Mailing Address - Country:US
Mailing Address - Phone:252-767-9229
Mailing Address - Fax:
Practice Address - Street 1:3105 N CROATAN HWY UNIT 27
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-6962
Practice Address - Country:US
Practice Address - Phone:252-449-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC406171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist