Provider Demographics
NPI:1265713945
Name:HUMPHREY-LECLAIRE, HEATHER J (LCMHC, LADC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:HUMPHREY-LECLAIRE
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2827
Mailing Address - Country:US
Mailing Address - Phone:802-345-7674
Mailing Address - Fax:
Practice Address - Street 1:38 PARK PL
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2827
Practice Address - Country:US
Practice Address - Phone:802-345-7674
Practice Address - Fax:802-257-7377
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0124491101YA0400X
VT000551101YA0400X
VT068.0083833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)