Provider Demographics
NPI:1295961845
Name:DISTIN, HEATHER V (LPCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:V
Last Name:DISTIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MIDWAY BLVD
Mailing Address - Street 2:#200
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-324-5701
Mailing Address - Fax:440-324-9978
Practice Address - Street 1:347 MIDWAY BLVD
Practice Address - Street 2:#200
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-324-5701
Practice Address - Fax:440-324-9978
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0501357101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor