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Individual
MICHAEL WAYNE HETHERINGTON
Active
Individual
MICHAEL WAYNE HETHERINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BBH-LCPC-LIC-26162
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477745370
—
MT
Enumeration date
12/14/2017
Last updated
01/24/2022
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