Provider Demographics
NPI:1174280747
Name:HEAVNER, DAVID JASON (EDD, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JASON
Last Name:HEAVNER
Suffix:
Gender:M
Credentials:EDD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OAK DR
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9237
Mailing Address - Country:US
Mailing Address - Phone:724-353-9505
Mailing Address - Fax:
Practice Address - Street 1:107 OAK DR
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9237
Practice Address - Country:US
Practice Address - Phone:724-353-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional