Provider Demographics
NPI:1811018500
Name:HEFNER, ROSE ANN (LPC , LSW)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:ANN
Last Name:HEFNER
Suffix:
Gender:F
Credentials:LPC , LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LEON SULLIVAN WAY
Mailing Address - Street 2:STE. 300
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2402
Mailing Address - Country:US
Mailing Address - Phone:304-346-9689
Mailing Address - Fax:304-345-4601
Practice Address - Street 1:16 LEON SULLIVAN WAY
Practice Address - Street 2:STE. 300
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2402
Practice Address - Country:US
Practice Address - Phone:304-346-9689
Practice Address - Fax:304-345-4601
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1547101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X
WVAP00941696104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker