Provider Demographics
NPI:1346640323
Name:HANES, HEIDI RENEE (LCPC, LCADC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:RENEE
Last Name:HANES
Suffix:
Gender:F
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1128
Mailing Address - Country:US
Mailing Address - Phone:410-852-0733
Mailing Address - Fax:
Practice Address - Street 1:2620 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7305
Practice Address - Country:US
Practice Address - Phone:410-573-5423
Practice Address - Fax:410-573-5401
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4573101YP2500X
MDLCA1992101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)