Provider Demographics
NPI:1619038130
Name:HECKATHORN, KEVIN (MA, PCC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HECKATHORN
Suffix:
Gender:M
Credentials:MA, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 HEMPSTEAD CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2511
Mailing Address - Country:US
Mailing Address - Phone:614-891-7840
Mailing Address - Fax:
Practice Address - Street 1:975 S SUNBURY RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9345
Practice Address - Country:US
Practice Address - Phone:614-865-0513
Practice Address - Fax:614-882-1380
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional