Provider Demographics
NPI:1518311794
Name:LOVELACE, HEATHER L (LCPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3122
Mailing Address - Country:US
Mailing Address - Phone:770-283-9168
Mailing Address - Fax:
Practice Address - Street 1:143 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3122
Practice Address - Country:US
Practice Address - Phone:770-283-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006545101YP2500X
IL180013926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180013926OtherLCPC