Healthcare Provider Details

I. General information

NPI: 1801191630
Provider Name (Legal Business Name): HEITT CLINICAL AND CORPORATE CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RESERVOIR CIR STE 105
PIKESVILLE MD
21208-6362
US

IV. Provider business mailing address

8 RESERVOIR CIR STE 105
PIKESVILLE MD
21208-6362
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3448
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL HEITT
Title or Position: PRESIDENT
Credential: PSYD
Phone: 410-580-9047