Provider Demographics
NPI:1538394051
Name:SMITH STEWART, HEATHER D (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:D
Last Name:SMITH STEWART
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 FIRST COLONIAL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3197
Mailing Address - Country:US
Mailing Address - Phone:757-502-8992
Mailing Address - Fax:
Practice Address - Street 1:915 FIRST COLONIAL RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3197
Practice Address - Country:US
Practice Address - Phone:757-502-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CT000050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
11244604OtherCAQH