Healthcare Provider Details

I. General information

NPI: 1003020249
Provider Name (Legal Business Name): HEATHER FREDERICK LPC, CAADC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 LEWIS AVE STE C
TEMPERANCE MI
48182-1465
US

IV. Provider business mailing address

7250 DOUGLAS RD
LAMBERTVILLE MI
48144-9488
US

V. Phone/Fax

Practice location:
  • Phone: 734-224-3761
  • Fax:
Mailing address:
  • Phone: 734-652-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: