Healthcare Provider Details

I. General information

NPI: 1659517787
Provider Name (Legal Business Name): HEATHER ANN LOCKE M.A., ED.M,, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 PECKHAM HOLLOW RD
CHARLESTOWN RI
02813-2722
US

IV. Provider business mailing address

99 PECKHAM HOLLOW RD
CHARLESTOWN RI
02813-2722
US

V. Phone/Fax

Practice location:
  • Phone: 303-903-9552
  • Fax:
Mailing address:
  • Phone: 303-903-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.00585
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0014867
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00392
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001244
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: