Provider Demographics
NPI:1437419074
Name:HENDRICKS, DANETTA ELIZABETH (MA, MSW, LGSW)
Entity Type:Individual
Prefix:MS
First Name:DANETTA
Middle Name:ELIZABETH
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MA, MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5364 SMOOTH MEADOW WAY
Mailing Address - Street 2:UNIT 12
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1765
Mailing Address - Country:US
Mailing Address - Phone:443-257-3590
Mailing Address - Fax:
Practice Address - Street 1:901 1ST ST NW
Practice Address - Street 2:C/O VMT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1403
Practice Address - Country:US
Practice Address - Phone:904-432-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500786501041C0700X
MDG128081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical