Healthcare Provider Details

I. General information

NPI: 1861209561
Provider Name (Legal Business Name): CHANA HAZINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655A OLD COURT RD STE 1
BALTIMORE MD
21208-3959
US

IV. Provider business mailing address

3002 TEMPLE GATE RD
BALTIMORE MD
21209-3800
US

V. Phone/Fax

Practice location:
  • Phone: 410-630-9064
  • Fax:
Mailing address:
  • Phone: 410-530-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP15934
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: