Provider Demographics
NPI:1639597867
Name:HEAVILIN, NICOLE (LPCC-S)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HEAVILIN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HEAVILIN RD
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43976-7702
Mailing Address - Country:US
Mailing Address - Phone:724-766-5276
Mailing Address - Fax:
Practice Address - Street 1:201 HEAVILIN RD
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:OH
Practice Address - Zip Code:43976-7702
Practice Address - Country:US
Practice Address - Phone:724-766-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCC1400127101YM0800X
101YP2500X
OHE.1700064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional