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General NPI Number Information
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NPI Number | 1245706662
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Entity Type | Individual
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Provider Name | DAKOTA CHANCE THOMAS HESHELMAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 05/07/2023
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Provider Practice Location Address
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Address Line | 973 N MAIN ST APT 1
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City | ROCKFORD
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State | IL
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Zip | 61103-7031
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Country | US
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Telephone | 815-558-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 WINDSOR RD UNIT #15291
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City | LOVES PARK
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State | IL
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Zip | 61132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.011840
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License Number State | IL
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