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General NPI Number Information
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NPI Number | 1275025512
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Entity Type | Individual
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Provider Name | ANTHONY DER LCPC
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Gender | Male
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Dates
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Enumeration Date | 06/02/2018
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Last Update Date | 06/02/2018
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Provider Practice Location Address
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Address Line | 10705 CHARTER DR STE 410
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City | COLUMBIA
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State | MD
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Zip | 21044-2800
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Country | US
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Telephone | 443-718-0385
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 CAMBRIA TER
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City | ELKRIDGE
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State | MD
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Zip | 21075-5952
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Country | US
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Telephone | 443-718-0385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC8466
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License Number State | MD
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