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NPI Code Detail

MEDICARE: MS. DANETTA ELIZABETH HENDRICKS MA, MSW, LGSW

MEDICARE: MS. DANETTA ELIZABETH HENDRICKS MA, MSW, LGSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLG50078650DC
21041C0700XClinical Social WorkerG12808MD

General Provider Information

NPI Number : 1437419074
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DANETTA ELIZABETH HENDRICKS MA, MSW, LGSW
Provider Business Mailing Address
First Line : 5364 SMOOTH MEADOW WAY
Second Line : UNIT 12
City : COLUMBIA
State : MD
Zip : 21044-1765
Country : US
Telephone Number : 443-257-3590
Fax Number :
Provider Business Practice Location Address
First Line : 901 1ST ST NW
Second Line : C/O VMT
City : WASHINGTON
State : DC
Zip : 20001-1403
Country : US
Telephone Number : 904-432-5735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2012
Last Update Date : 05/16/2012

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