Provider Demographics
NPI:1568588895
Name:ANDREW STANTON LCSWC PC
Entity Type:Organization
Organization Name:ANDREW STANTON LCSWC PC
Other - Org Name:STANTON PSYCHOTHERAPY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-546-4476
Mailing Address - Street 1:8850 COLUMBIA 100 PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-707-1267
Mailing Address - Fax:443-546-4473
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-707-1267
Practice Address - Fax:443-546-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08831104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty