Individual
HEATHER RAYAN PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, ALPS, NCC, AADC
Contact information
Practice address
1718 WONDERLAND RD, FAYETTEVILLE, WV 25840-5248
(304) 543-8289
Mailing address
1718 WONDERLAND RD, FAYETTEVILLE, WV 25840-5248
(304) 543-8289
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0360
KY
101YP2500X
Professional Counselor
Primary
2466
WV
101YP2500X
Professional Counselor
8145S
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487757787
—
NC
05
—
1487757787
—
WV
05
—
30610026
—
KY
Enumeration date
09/06/2006
Last updated
07/15/2021
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