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General NPI Number Information
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NPI Number | 1922621051
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Entity Type | Individual
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Provider Name | ANDREA ELLIS LGPC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2020
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Last Update Date | 05/23/2020
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Provider Practice Location Address
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Address Line | 1110 BENFIELD BLVD
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City | MILLERSVILLE
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State | MD
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Zip | 21108-2639
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Country | US
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Telephone | 410-756-0035
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Fax |
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Provider Business Mailing Address
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Address Line | 13115 LARCHDALE RD APT 12
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City | LAUREL
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State | MD
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Zip | 20708-1753
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Country | US
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Telephone | 240-595-0892
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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 | LGP10366
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License Number State | MD
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