Provider Demographics
NPI:1780912261
Name:CUSTER, HEATHER MITCHELL (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MITCHELL
Last Name:CUSTER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2706
Mailing Address - Country:US
Mailing Address - Phone:540-443-7512
Mailing Address - Fax:540-961-8469
Practice Address - Street 1:700 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2706
Practice Address - Country:US
Practice Address - Phone:540-443-7512
Practice Address - Fax:540-961-8469
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701004706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health