Provider Demographics
NPI:1508075003
Name:VANDERWALDE, HEIDI PAULA (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:PAULA
Last Name:VANDERWALDE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7238 MUNCASTER MILL RD STE 306
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1215
Mailing Address - Country:US
Mailing Address - Phone:301-869-1334
Mailing Address - Fax:301-366-0824
Practice Address - Street 1:7238 MUNCASTER MILL RD STE 306
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1215
Practice Address - Country:US
Practice Address - Phone:301-869-1334
Practice Address - Fax:301-366-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC 1058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional