Provider Demographics
NPI:1710109897
Name:VAN DER HEIDEN, KATHRYN P (LPCC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:P
Last Name:VAN DER HEIDEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 REGENCY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4252
Mailing Address - Country:US
Mailing Address - Phone:937-439-5009
Mailing Address - Fax:937-439-4316
Practice Address - Street 1:351 REGENCY RIDGE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4252
Practice Address - Country:US
Practice Address - Phone:937-439-5009
Practice Address - Fax:937-439-4316
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0000991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health