Provider Demographics
NPI:1306356233
Name:HEADLEY, LUCINDA SUE (BS CADC-M)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:SUE
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:BS CADC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 READING AVE
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1136
Mailing Address - Country:US
Mailing Address - Phone:517-849-2330
Mailing Address - Fax:
Practice Address - Street 1:110 READING AVE
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1136
Practice Address - Country:US
Practice Address - Phone:517-849-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIT-00102101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)