Provider Demographics
NPI:1902558695
Name:HALL, HEATHER JANE (LMSW, LGSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JANE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 PINE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5519
Mailing Address - Country:US
Mailing Address - Phone:651-231-5933
Mailing Address - Fax:
Practice Address - Street 1:1205 DOLLEY MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3019
Practice Address - Country:US
Practice Address - Phone:703-335-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09030033361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty