Provider Demographics
NPI:1013075266
Name:SPRINGSTON, MARK DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DOUGLAS
Last Name:SPRINGSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:301-965-8264
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3898103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist