Provider Demographics
NPI:1679158851
Name:LAFOND, HEATHER NICOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:LAFOND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANNE
Mailing Address - State:IL
Mailing Address - Zip Code:60964-5479
Mailing Address - Country:US
Mailing Address - Phone:630-863-8169
Mailing Address - Fax:
Practice Address - Street 1:500 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2328
Practice Address - Country:US
Practice Address - Phone:815-828-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health