Provider Demographics
NPI:1922625953
Name:CANTERBURY, ANDREW (LGPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CANTERBURY
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY S STE 503
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6443
Mailing Address - Country:US
Mailing Address - Phone:443-354-1200
Mailing Address - Fax:410-553-0019
Practice Address - Street 1:1600 CRAIN HWY S STE 503
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6443
Practice Address - Country:US
Practice Address - Phone:443-354-1200
Practice Address - Fax:410-553-0019
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health