Provider Demographics
NPI:1518775295
Name:NATHAN HEFNER LPC PC
Entity type:Organization
Organization Name:NATHAN HEFNER LPC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-316-1826
Mailing Address - Street 1:2340 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2340 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1634
Practice Address - Country:US
Practice Address - Phone:434-249-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty