Provider Demographics
NPI:1215971080
Name:HEFFER, CAROL ROSE (LCMHC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ROSE
Last Name:HEFFER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CEDAR GLN N
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7334
Mailing Address - Country:US
Mailing Address - Phone:802-865-2036
Mailing Address - Fax:
Practice Address - Street 1:366 DORSET ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6209
Practice Address - Country:US
Practice Address - Phone:802-654-7607
Practice Address - Fax:802-654-9155
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT68167OtherBCBS
VT356438OtherMHN/TRICARE
VT1010317Medicaid
VT14Y008909VT01OtherBHN
VT785928OtherMVP