Provider Demographics
NPI:1376917757
Name:MARK SPRINGSTON, PHD
Entity Type:Organization
Organization Name:MARK SPRINGSTON, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-788-5351
Mailing Address - Street 1:8101 FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7624
Mailing Address - Country:US
Mailing Address - Phone:301-788-5351
Mailing Address - Fax:
Practice Address - Street 1:3390 URBANA PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7769
Practice Address - Country:US
Practice Address - Phone:301-788-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3898103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty