Provider Demographics
NPI:1568428894
Name:LOVELACE, PATRICIA GAIL (LPCS, ASDC, NCC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GAIL
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:LPCS, ASDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SIMONAKI WAY
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-8279
Mailing Address - Country:US
Mailing Address - Phone:256-710-4640
Mailing Address - Fax:256-229-6272
Practice Address - Street 1:11631 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:AL
Practice Address - Zip Code:35648-3249
Practice Address - Country:US
Practice Address - Phone:256-229-6262
Practice Address - Fax:256-229-6272
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2860101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21916OtherBCBS OF AL