Provider Demographics
NPI:1780937490
Name:HEAGLE, ELIZABETH C (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:C
Last Name:HEAGLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:C
Other - Last Name:HEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:409 VLEY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2607
Mailing Address - Country:US
Mailing Address - Phone:518-366-0133
Mailing Address - Fax:
Practice Address - Street 1:409 VLEY RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2607
Practice Address - Country:US
Practice Address - Phone:518-366-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001916-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health