Provider Demographics
NPI:1952023384
Name:ANDERSON, BRIA
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:ANDERSON
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 1:301 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6823
Mailing Address - Country:US
Mailing Address - Phone:202-878-0783
Mailing Address - Fax:
Practice Address - Street 1:5044 DORSEY HALL DR STE 204
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7500
Practice Address - Country:US
Practice Address - Phone:410-884-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28738104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD47-5577533Medicaid
MD47-5577533OtherNON MEDICARE