Healthcare Provider Details

I. General information

NPI: 1316282775
Provider Name (Legal Business Name): ANDREA DILORENZO LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E DIAMOND AVE SUITE 100
GAITHERSBURG MD
20877-5323
US

IV. Provider business mailing address

610 E DIAMOND AVE SUITE 100
GAITHERSBURG MD
20877-5323
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3200
  • Fax: 301-840-1348
Mailing address:
  • Phone: 301-840-3200
  • Fax: 301-840-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP4130
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: