Provider Demographics
NPI:1760676605
Name:BAINBRIDGE, ANDREA ANYSIA
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:ANYSIA
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 GEORGIA AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2713
Mailing Address - Country:US
Mailing Address - Phone:301-563-7000
Mailing Address - Fax:301-563-7000
Practice Address - Street 1:8818 GEORGIA AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2713
Practice Address - Country:US
Practice Address - Phone:301-563-7000
Practice Address - Fax:301-563-7000
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health