Provider Demographics
NPI:1114443884
Name:HADZIC, ELIZABETH (LCSWC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HADZIC
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 SPRINGWATER TER
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7658
Mailing Address - Country:US
Mailing Address - Phone:806-438-8434
Mailing Address - Fax:
Practice Address - Street 1:15825 SHADY GROVE RD STE 35
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4033
Practice Address - Country:US
Practice Address - Phone:301-672-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0000000Medicaid