Provider Demographics
NPI:1154347821
Name:STANLEY, HEATHER (LCSW-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STANLEY
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 1:11 NEWBURG AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:443-840-6620
Mailing Address - Fax:
Practice Address - Street 1:11 NEWBURG AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5108
Practice Address - Country:US
Practice Address - Phone:443-840-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10933104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker