Healthcare Provider Details

I. General information

NPI: 1154482644
Provider Name (Legal Business Name): MICHAEL LAWRENCE HENDRICKS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW SUITE 513
WASHINGTON DC
20015-2014
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW SUITE 513
WASHINGTON DC
20015-2014
US

V. Phone/Fax

Practice location:
  • Phone: 202-364-1575
  • Fax: 202-364-0561
Mailing address:
  • Phone: 202-364-1575
  • Fax: 202-364-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1789
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002098
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03197
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0810002098
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY1789
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: