Provider Demographics
NPI:1871006304
Name:EVERSOLE, HEIDI (MA, LPC, TF-CBT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:MA, LPC, TF-CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9078 UNION CENTRE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4992
Mailing Address - Country:US
Mailing Address - Phone:513-613-4726
Mailing Address - Fax:513-964-9029
Practice Address - Street 1:9078 UNION CENTRE BLVD STE 350
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4992
Practice Address - Country:US
Practice Address - Phone:513-613-4726
Practice Address - Fax:513-964-9029
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1801364OtherOHIO SOCIAL WORKER, COUNSELOR AND MARRIAGE AND FAMILY COUNSELING BOARD
OH01-0693OtherCARF
OH0074946OtherODMH
OH0074861OtherODADAS
OHH130910OtherPTAN GROUP