Healthcare Provider Details

I. General information

NPI: 1710847124
Provider Name (Legal Business Name): HANA KASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 RINES TAVERN LN
FREDERICK MD
21704-7899
US

IV. Provider business mailing address

3504 RINES TAVERN LN
FREDERICK MD
21704-7899
US

V. Phone/Fax

Practice location:
  • Phone: 202-913-5541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: