Provider Demographics
NPI:1598269227
Name:ANDREW, KELLY (LCSWC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ANDREW
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10632 LITTLE PATUXENT PKWY STE 327
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6283
Mailing Address - Country:US
Mailing Address - Phone:443-864-5647
Mailing Address - Fax:443-276-0905
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY STE 327
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6283
Practice Address - Country:US
Practice Address - Phone:443-864-5647
Practice Address - Fax:443-276-0905
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty