Provider Demographics
NPI:1154482644
Name:HENDRICKS, MICHAEL LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 513
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2014
Mailing Address - Country:US
Mailing Address - Phone:202-364-1575
Mailing Address - Fax:202-364-0561
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 513
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2014
Practice Address - Country:US
Practice Address - Phone:202-364-1575
Practice Address - Fax:202-364-0561
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1789103TC0700X, 103TF0200X
VA0810002098103TC0700X, 103TF0200X
MD03197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC410271 005561W71Medicare ID - Type Unspecified