Provider Demographics
NPI:1548711740
Name:O'SHAUGHNESSY, HEATHER (LCPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 OAKBOROUGH SQ
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1718
Mailing Address - Country:US
Mailing Address - Phone:301-204-5719
Mailing Address - Fax:
Practice Address - Street 1:18506 SNOWBERRY WAY
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1570
Practice Address - Country:US
Practice Address - Phone:301-204-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health