Provider Demographics
NPI:1720583859
Name:HEUVELMAN-HUTCHINSON, LORENE R (MS, EDS, PSYD)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:R
Last Name:HEUVELMAN-HUTCHINSON
Suffix:
Gender:F
Credentials:MS, EDS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SE MAIN ST STE 203A
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2673
Mailing Address - Country:US
Mailing Address - Phone:678-230-0476
Mailing Address - Fax:
Practice Address - Street 1:419 SE MAIN ST STE 203A
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2673
Practice Address - Country:US
Practice Address - Phone:678-230-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4673103TS0200X
SC6802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool