Provider Demographics
NPI:1619529534
Name:HEATHERLY, KATHERINE W (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:W
Last Name:HEATHERLY
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VALLEY HEALTH CARE, INC
Practice Address - Street 2:46 TOWN CENTER PLAZA, SUITE A
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional