Provider Demographics
NPI:1609847201
Name:HEINER, BERTIE D (LPC)
Entity Type:Individual
Prefix:MS
First Name:BERTIE
Middle Name:D
Last Name:HEINER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4841
Mailing Address - Country:US
Mailing Address - Phone:434-872-0047
Mailing Address - Fax:434-872-0049
Practice Address - Street 1:1007 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4841
Practice Address - Country:US
Practice Address - Phone:434-872-0047
Practice Address - Fax:434-872-0049
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA145977OtherANTHEM