Provider Demographics
NPI:1679276919
Name:STUBE, HEATHER DARBY (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DARBY
Last Name:STUBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 STARR ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3612
Mailing Address - Country:US
Mailing Address - Phone:610-563-1105
Mailing Address - Fax:
Practice Address - Street 1:315 S ALLEN ST STE 326
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4851
Practice Address - Country:US
Practice Address - Phone:814-308-0704
Practice Address - Fax:814-308-0705
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty