Provider Demographics
NPI:1710201306
Name:QUE, HEIDI MARIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:QUE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:HEIDE
Other - Middle Name:MARIE
Other - Last Name:WILLEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1931 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4113
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:410-308-8926
Practice Address - Street 1:1931 GREENSPRING DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4113
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:410-308-8926
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13664OtherLICENSE