Provider Demographics
NPI:1326079401
Name:PESTA, HEATHER LEA (MS LCPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEA
Last Name:PESTA
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:LEA
Other - Last Name:HOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 BISHOP WALSH RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-777-0451
Mailing Address - Fax:301-777-3071
Practice Address - Street 1:925 BISHOP WALSH RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-777-0451
Practice Address - Fax:301-777-3071
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1658101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor