Provider Demographics
NPI:1750112975
Name:HETZER, ANN PLASTER (MED)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:PLASTER
Last Name:HETZER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 MECHANICSVILLE ELEMENTARY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1792
Mailing Address - Country:US
Mailing Address - Phone:804-723-3640
Mailing Address - Fax:
Practice Address - Street 1:7425 MECHANICSVILLE ELEMENTARY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1792
Practice Address - Country:US
Practice Address - Phone:804-723-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool