Provider Demographics
NPI:1669630042
Name:GRIFFIN, ANDREA (PHD PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11381 LAURELWALK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3006
Mailing Address - Country:US
Mailing Address - Phone:301-524-5110
Mailing Address - Fax:
Practice Address - Street 1:1662 VILLAGE GRN STE 100
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2014
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000399103TC1900X
MD04462103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling