Provider Demographics
NPI:1619942125
Name:HAWKINS-HEITT, SANDRA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MICHELLE
Last Name:HAWKINS-HEITT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 WESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3932
Mailing Address - Country:US
Mailing Address - Phone:410-823-3736
Mailing Address - Fax:
Practice Address - Street 1:6 RESERVOIR CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6374
Practice Address - Country:US
Practice Address - Phone:410-580-9047
Practice Address - Fax:410-580-9046
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical