Provider Demographics
NPI:1790049187
Name:VANCE, HEIDI KATHRYN (LPC-A)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KATHRYN
Last Name:VANCE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PURDUE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5509
Mailing Address - Country:US
Mailing Address - Phone:910-867-8889
Mailing Address - Fax:
Practice Address - Street 1:1540 PURDUE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5509
Practice Address - Country:US
Practice Address - Phone:910-867-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional