Provider Demographics
NPI:1184331845
Name:MANCE, HESHIMA (LCPC)
Entity type:Individual
Prefix:
First Name:HESHIMA
Middle Name:
Last Name:MANCE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-0020
Mailing Address - Country:US
Mailing Address - Phone:312-525-1031
Mailing Address - Fax:
Practice Address - Street 1:4449 S LAKE PARK AVE UNIT 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4189
Practice Address - Country:US
Practice Address - Phone:312-525-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015103101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor