Provider Demographics
NPI:1093364499
Name:DEGROAT, SAFRIANNA ALYSSA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:SAFRIANNA
Middle Name:ALYSSA MARIE
Last Name:DEGROAT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E PATRICK ST # 108
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5630
Mailing Address - Country:US
Mailing Address - Phone:240-490-4306
Mailing Address - Fax:
Practice Address - Street 1:122 E PATRICK ST # 108
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5630
Practice Address - Country:US
Practice Address - Phone:240-490-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8423101YP2500X
MDLC10745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional