Provider Demographics
NPI:1407420532
Name:BLANC, HEIDI NOELLE (LPC)
Entity Type:Individual
Prefix:
First Name:HEIDI NOELLE
Middle Name:
Last Name:BLANC
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 MOUNTAINSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9562
Mailing Address - Country:US
Mailing Address - Phone:206-669-9999
Mailing Address - Fax:
Practice Address - Street 1:174 S FRANKLIN ST STE 206
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1347
Practice Address - Country:US
Practice Address - Phone:206-669-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health