Provider Demographics
NPI:1952871956
Name:BURRILL, AMANDA CLAIRE (MS, LGPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CLAIRE
Last Name:BURRILL
Suffix:
Gender:F
Credentials:MS, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 CRYSTAL CT UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3194
Mailing Address - Country:US
Mailing Address - Phone:410-241-6213
Mailing Address - Fax:
Practice Address - Street 1:77 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5037
Practice Address - Country:US
Practice Address - Phone:410-241-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLG9180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health