Healthcare Provider Details

I. General information

NPI: 1982899092
Provider Name (Legal Business Name): STEVEN ADAM HEFTER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ANNAPOLIS RD STE. 202
ODENTON MD
21113-1344
US

IV. Provider business mailing address

3335 ELM AVE
BALTIMORE MD
21211-2726
US

V. Phone/Fax

Practice location:
  • Phone: 410-519-1209
  • Fax:
Mailing address:
  • Phone: 443-956-6850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2417
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: