Provider Demographics
NPI:1043921448
Name:GARRIS, ANDREA R
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:R
Last Name:GARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12774 WISTERIA DR
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-7649
Mailing Address - Country:US
Mailing Address - Phone:240-200-4068
Mailing Address - Fax:
Practice Address - Street 1:12774 WISTERIA DRIVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20875-7649
Practice Address - Country:US
Practice Address - Phone:240-200-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health