Provider Demographics
NPI:1114059110
Name:LIPPINCOTT, HEATHER ELLIS (MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELLIS
Last Name:LIPPINCOTT
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 BERNHARDT CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3962
Mailing Address - Country:US
Mailing Address - Phone:910-617-5160
Mailing Address - Fax:
Practice Address - Street 1:5502 BERNHARDT CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-3962
Practice Address - Country:US
Practice Address - Phone:910-617-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC995101YA0400X
NCC0073131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111869OtherLCAS