Provider Demographics
NPI:1003020249
Name:FREDERICK, HEATHER (LPC, CAADC, CCS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LPC, CAADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9488
Mailing Address - Country:US
Mailing Address - Phone:734-652-6782
Mailing Address - Fax:
Practice Address - Street 1:7355 LEWIS AVE STE C
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1465
Practice Address - Country:US
Practice Address - Phone:734-224-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)