Provider Demographics
NPI:1407915440
Name:HEAGY, JAMES L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:HEAGY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAIN ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2726
Mailing Address - Country:US
Mailing Address - Phone:304-639-8140
Mailing Address - Fax:304-232-0120
Practice Address - Street 1:1025 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-639-8140
Practice Address - Fax:304-232-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00938721104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005456001Medicaid
WV001718897OtherMSBCBS ID NUMBER
WV2114778OtherCIGNA ID NUMBER
WVY938721OtherHEALTH PLAN ID NUMBER
WV484433000OtherMAGELLAN MIS NUMBER