Provider Demographics
NPI:1861209561
Name:HAZINS, CHANA
Entity type:Individual
Prefix:
First Name:CHANA
Middle Name:
Last Name:HAZINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 TEMPLE GATE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3800
Mailing Address - Country:US
Mailing Address - Phone:410-530-6141
Mailing Address - Fax:
Practice Address - Street 1:3655A OLD COURT RD STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3959
Practice Address - Country:US
Practice Address - Phone:410-630-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional