Provider Demographics
NPI:1538986864
Name:HERON'S NEST COUNSELING, PLLC
Entity type:Organization
Organization Name:HERON'S NEST COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTALLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HERON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-212-9202
Mailing Address - Street 1:655 CARSON DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4323
Mailing Address - Country:US
Mailing Address - Phone:540-212-9202
Mailing Address - Fax:
Practice Address - Street 1:655 CARSON DR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4323
Practice Address - Country:US
Practice Address - Phone:540-212-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992325658Medicaid