Provider Demographics
NPI:1013467679
Name:HEAVEY, JEAN (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:HEAVEY
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9933 US 70 BUSINESS HWY W
Mailing Address - Street 2:PO BOX 1418
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2113
Mailing Address - Country:US
Mailing Address - Phone:919-585-2069
Mailing Address - Fax:919-585-2075
Practice Address - Street 1:9933 US 70 BUSINESS HWY W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2113
Practice Address - Country:US
Practice Address - Phone:919-585-2069
Practice Address - Fax:919-585-2075
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12550101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor