Provider Demographics
NPI:1952158990
Name:GOUNDRY, ANDREA T (LGPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:GOUNDRY
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:ADOLPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 BELFAST RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4201
Mailing Address - Country:US
Mailing Address - Phone:717-497-8309
Mailing Address - Fax:
Practice Address - Street 1:9649 BELAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1117
Practice Address - Country:US
Practice Address - Phone:410-529-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health