Provider Demographics
NPI:1487907002
Name:BURCH, HEIDE (PHD)
Entity type:Individual
Prefix:DR
First Name:HEIDE
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6561 HAZEL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-5679
Mailing Address - Country:US
Mailing Address - Phone:518-480-7066
Mailing Address - Fax:518-636-1882
Practice Address - Street 1:333 GLEN ST STE 200F
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3666
Practice Address - Country:US
Practice Address - Phone:518-480-7066
Practice Address - Fax:518-636-1882
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC6491101YM0800X
NY006398101YM0800X
VA0701012253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health