Healthcare Provider Details

I. General information

NPI: 1619942125
Provider Name (Legal Business Name): SANDRA MICHELLE HAWKINS-HEITT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RESERVOIR CIR SUITE 201
BALTIMORE MD
21208-6374
US

IV. Provider business mailing address

8507 WESTFORD RD
LUTHERVILLE MD
21093-3932
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-9047
  • Fax: 410-580-9046
Mailing address:
  • Phone: 410-823-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3538
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: