Provider Demographics
NPI:1558031591
Name:HEINEMANN, RACHEL (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:HEINEMANN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 WICKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2545
Mailing Address - Country:US
Mailing Address - Phone:973-271-5647
Mailing Address - Fax:
Practice Address - Street 1:3655 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3905
Practice Address - Country:US
Practice Address - Phone:410-630-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional