Healthcare Provider Details

I. General information

NPI: 1346640323
Provider Name (Legal Business Name): HEIDI RENEE HANES LCPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 RIVA RD
ANNAPOLIS MD
21401-7305
US

IV. Provider business mailing address

7195 OHIO AVE
HANOVER MD
21076-1128
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-5423
  • Fax: 410-573-5401
Mailing address:
  • Phone: 410-852-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA1992
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4573
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: