Provider Demographics
NPI:1447044169
Name:HALWICK, MICHELLY
Entity type:Individual
Prefix:
First Name:MICHELLY
Middle Name:
Last Name:HALWICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 ABERDEEN CIR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1635
Mailing Address - Country:US
Mailing Address - Phone:410-707-6078
Mailing Address - Fax:
Practice Address - Street 1:1773 ABERDEEN CIR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1635
Practice Address - Country:US
Practice Address - Phone:410-707-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-25-425674106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician