Provider Demographics
NPI:1407615321
Name:CARNES, HEATHER (MA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CARNES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 POND BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:25187-8559
Mailing Address - Country:US
Mailing Address - Phone:304-939-8416
Mailing Address - Fax:
Practice Address - Street 1:4 PUTNAM VILLAGE DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1354
Practice Address - Country:US
Practice Address - Phone:304-757-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)