Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC10825 | MD |
NPI | 1003419300 |
---|---|
Provider Name | Corinne Heiliger |
First Address | Columbia, MD 21045-4304 |
Second Address | Ellicott City, MD 21043-4559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 18/11/2020 |