Provider Demographics
NPI:1417259599
Name:CROMWELL, HEATHER JORDAN (PHD, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JORDAN
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:SITKA COUNSELING AND PREVENTION
Mailing Address - Street 2:113 METLAKATIA STREET
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835
Mailing Address - Country:US
Mailing Address - Phone:907-747-3636
Mailing Address - Fax:907-747-2702
Practice Address - Street 1:SITKA COUNSELING AND PREVENTION
Practice Address - Street 2:113 METLAKATIA STREET
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835
Practice Address - Country:US
Practice Address - Phone:907-747-3636
Practice Address - Fax:907-747-2702
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AK182866101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor