Provider Information for 1487757787
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HEATHER RAYAN PACK LPC, ALPS, NCC, AADC
Sex: Female
NPI: 1487757787
Last Updated: 2021-07-15
Certification Date: 2021-07-13
Certification Date: 2021-07-13
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1487757787 | ||||||||||||||||
| Enumeration Date | 2006-09-06 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 1718 WONDERLAND RD FAYETTEVILLE, WV 25840-5248 United States Phone: 304-543-8289 | Fax: | ||||||||||||||||
| Primary Practice Address | 1718 WONDERLAND RD FAYETTEVILLE, WV 25840-5248 United States Phone: 304-543-8289 | Fax: | ||||||||||||||||
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