Provider Demographics
NPI:1942892054
Name:SNOW-HEINZ, KELLY (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SNOW-HEINZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6923 EMMA CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8963
Mailing Address - Country:US
Mailing Address - Phone:540-229-4920
Mailing Address - Fax:
Practice Address - Street 1:12 N HILL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2610
Practice Address - Country:US
Practice Address - Phone:540-347-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional