Provider Demographics
NPI:1609312701
Name:FITE, HEATHER RENEE (LCISW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:FITE
Suffix:
Gender:F
Credentials:LCISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 MIDNOON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3881
Mailing Address - Country:US
Mailing Address - Phone:304-279-5553
Mailing Address - Fax:
Practice Address - Street 1:59 RULAND RD STE H-4
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-2887
Practice Address - Country:US
Practice Address - Phone:304-279-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22318104100000X
WVDP009450311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker