MEDICARE: ANDREW CANTERBURY LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC12314	MD

General Provider Information

NPI Number	:	1922625953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CANTERBURY LCPC

Provider Business Mailing Address
First Line	:	4925 ARBORGATE CIR
Second Line	:
City	:	HALETHORPE
State	:	MD
Zip	:	21227-2561
Country	:	US
Telephone Number	:	410-428-8778
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 E MAIN ST
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5012
Country	:	US
Telephone Number	:	877-768-5544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	03/04/2025

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