Provider Demographics
NPI:1346738846
Name:ANDERSON, LAUREN AYCOCK (MS, LCMFT, NCC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:AYCOCK
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, LCMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 NEWBURY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3657
Mailing Address - Country:US
Mailing Address - Phone:443-687-9951
Mailing Address - Fax:
Practice Address - Street 1:5710 NEWBURY ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3657
Practice Address - Country:US
Practice Address - Phone:443-687-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist