Provider Demographics
NPI:1508077967
Name:HEARD, AZIZ S (LCPC, NCC, AS)
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:S
Last Name:HEARD
Suffix:
Gender:M
Credentials:LCPC, NCC, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1929
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-6929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15638 LIVINGSTON RD STE 5
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3330
Practice Address - Country:US
Practice Address - Phone:301-747-4470
Practice Address - Fax:301-747-4532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP323101YM0800X
MDLC3048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP323Medicaid