Healthcare Provider Details

I. General information

NPI: 1164357984
Provider Name (Legal Business Name): MILLICENT HENDRIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 WOODSIDE CT STE 350
COLUMBIA MD
21046-1042
US

IV. Provider business mailing address

104 CHURCH LN STE 101
BALTIMORE MD
21208-3839
US

V. Phone/Fax

Practice location:
  • Phone: 410-343-9756
  • Fax: 410-630-7096
Mailing address:
  • Phone: 410-343-9756
  • Fax: 410-630-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberA01196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: