Provider Demographics
NPI:1780220541
Name:HUIE, ELIZA JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:JANE
Last Name:HUIE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27237 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1049
Mailing Address - Country:US
Mailing Address - Phone:661-805-8235
Mailing Address - Fax:
Practice Address - Street 1:2600 MARRIOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1628
Practice Address - Country:US
Practice Address - Phone:443-419-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health