Provider Demographics
NPI:1467003715
Name:HEINZMAN, KELLY DENEEN (MED LPC LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DENEEN
Last Name:HEINZMAN
Suffix:
Gender:F
Credentials:MED LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 36TH RD N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4817
Mailing Address - Country:US
Mailing Address - Phone:703-625-4182
Mailing Address - Fax:
Practice Address - Street 1:1101 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2211
Practice Address - Country:US
Practice Address - Phone:703-625-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001713103TC1900X
VA0717000464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling