1689068835 NPI number — TAMMERRA HEWITT NCC, LCPC, LPC, ACS

Table of content: TAMMERRA HEWITT NCC, LCPC, LPC, ACS (NPI 1689068835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689068835 NPI number — TAMMERRA HEWITT NCC, LCPC, LPC, ACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEWITT
Provider First Name:
TAMMERRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NCC, LCPC, LPC, ACS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689068835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12138 CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 516
Provider Business Mailing Address City Name:
MITCHELLVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-603-6527
Provider Business Mailing Address Fax Number:
240-525-0852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12138 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 516
Provider Business Practice Location Address City Name:
MITCHELLVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20721-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-603-6527
Provider Business Practice Location Address Fax Number:
240-525-0852
Provider Enumeration Date:
03/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PRC14523 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LC4656 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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