Healthcare Provider Details

I. General information

NPI: 1629520689
Provider Name (Legal Business Name): LINDA KAY HENDRICK ADT-3802
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 SHERRY LN
PRINCE FREDERICK MD
20678-3231
US

IV. Provider business mailing address

335 CUSTER CT
LUSBY MD
20657-2510
US

V. Phone/Fax

Practice location:
  • Phone: 443-968-8331
  • Fax:
Mailing address:
  • Phone: 937-831-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3802
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: