Healthcare Provider Details

I. General information

NPI: 1043178080
Provider Name (Legal Business Name): ANDREYA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STRETHAM CT
OWINGS MILLS MD
21117-4739
US

IV. Provider business mailing address

31 STRETHAM CT
OWINGS MILLS MD
21117-4739
US

V. Phone/Fax

Practice location:
  • Phone: 240-415-8360
  • Fax:
Mailing address:
  • Phone: 240-415-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number31895
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31895
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: