Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC010937 | PA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1124680277 |
---|---|
Provider Name | Ann Marie A Hefferan |
First Address | Canonsburg, PA 15317-3906 |
Second Address | Washington, PA 15301-8130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |