Provider Demographics
NPI:1255602777
Name:LAWHENORE, ANGELIQUE JEANNE (MA, LPC, LADAC)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:JEANNE
Last Name:LAWHENORE
Suffix:
Gender:F
Credentials:MA, LPC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RUSKIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2522
Mailing Address - Country:US
Mailing Address - Phone:719-572-6100
Mailing Address - Fax:
Practice Address - Street 1:157 FONTAINE BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2110
Practice Address - Country:US
Practice Address - Phone:719-388-3558
Practice Address - Fax:719-694-9525
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0146551101YA0400X
NM0146561101YM0800X, 101YP2500X, 101Y00000X
COLPC.0012086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor