Provider Demographics
NPI:1982733069
Name:SANDRA HAWKINS HEITT, PSYD, PA
Entity Type:Organization
Organization Name:SANDRA HAWKINS HEITT, PSYD, PA
Other - Org Name:HEITT CLINICAL AND CORPORATE CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-580-9047
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health