Provider Demographics
NPI:1437207883
Name:MASK, HEATHER JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JEAN
Last Name:MASK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:CAVINESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3929 TINSLEY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1531
Mailing Address - Country:US
Mailing Address - Phone:336-841-4307
Mailing Address - Fax:336-841-7267
Practice Address - Street 1:3929 TINSLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1531
Practice Address - Country:US
Practice Address - Phone:336-841-4307
Practice Address - Fax:336-841-7267
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC182980OtherMEDCOST PROVIDER NUMBER
NC6102968Medicaid
NC7638492OtherAETNA PROVIDER NUMBER
NC242175OtherUNITED BEHAVIORAL HEALTH
NC135NKOtherBCBS PROVIDER NUMBER