Provider Demographics
NPI:1295341311
Name:HAYTMANEK, ELIZABETH (LGPC, NCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HAYTMANEK
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 E WEST HWY STE 350
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4565
Mailing Address - Country:US
Mailing Address - Phone:301-656-4600
Mailing Address - Fax:
Practice Address - Street 1:4416 E WEST HWY STE 350
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4565
Practice Address - Country:US
Practice Address - Phone:301-656-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty