Provider Demographics
NPI:1184086464
Name:GRANDEA, CORDIA
Entity type:Individual
Prefix:
First Name:CORDIA
Middle Name:
Last Name:GRANDEA
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 1:535 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2913
Mailing Address - Country:US
Mailing Address - Phone:443-798-0433
Mailing Address - Fax:
Practice Address - Street 1:535 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2913
Practice Address - Country:US
Practice Address - Phone:443-798-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP4090101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor