Provider Demographics
NPI:1568832624
Name:HYATT, NANCY DALE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DALE
Last Name:HYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 E WEST HWY
Mailing Address - Street 2:SUITE 509B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4522
Mailing Address - Country:US
Mailing Address - Phone:202-669-9898
Mailing Address - Fax:202-244-4253
Practice Address - Street 1:4405 E WEST HWY
Practice Address - Street 2:SUITE 509B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4522
Practice Address - Country:US
Practice Address - Phone:202-669-9898
Practice Address - Fax:202-244-4253
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health