Healthcare Provider Details

I. General information

NPI: 1679400535
Provider Name (Legal Business Name): ANDREW STEWART LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E FORT AVE STE 100
BALTIMORE MD
21230-5135
US

IV. Provider business mailing address

2331 YORK RD STE 100
TIMONIUM MD
21093-2246
US

V. Phone/Fax

Practice location:
  • Phone: 667-668-2566
  • Fax:
Mailing address:
  • Phone: 301-675-8313
  • Fax: 410-498-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17331
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: