Provider Demographics
NPI:1831589258
Name:VANKOUGHNETT, HEATHER (LPCA, NCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:VANKOUGHNETT
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 1:3029 SCOTTCREST WAY
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7461
Mailing Address - Country:US
Mailing Address - Phone:704-408-8895
Mailing Address - Fax:
Practice Address - Street 1:903 NORTHEAST DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7416
Practice Address - Country:US
Practice Address - Phone:704-896-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-24
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional