Provider Demographics
NPI:1982320719
Name:HETRICK, GINA (LPC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:HETRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:265 N FINDLEY ST STE D
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2064
Mailing Address - Country:US
Mailing Address - Phone:814-935-9019
Mailing Address - Fax:814-954-1550
Practice Address - Street 1:265 N FINDLEY ST STE D
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2064
Practice Address - Country:US
Practice Address - Phone:814-935-9019
Practice Address - Fax:814-954-1550
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional