Provider Demographics
NPI:1578878039
Name:DRIVER, HEATHER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DRIVER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4004
Mailing Address - Country:US
Mailing Address - Phone:540-434-2800
Mailing Address - Fax:540-434-2883
Practice Address - Street 1:110 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4004
Practice Address - Country:US
Practice Address - Phone:540-434-2800
Practice Address - Fax:540-434-2883
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578878039Medicaid