Provider Demographics
NPI:1912246620
Name:HENDRICKS, PAULETTE THERESA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:THERESA
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 WYNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6171
Mailing Address - Country:US
Mailing Address - Phone:410-960-4760
Mailing Address - Fax:
Practice Address - Street 1:4000 BLACKBURN LN STE 150
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6127
Practice Address - Country:US
Practice Address - Phone:301-421-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06378101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health