Provider Demographics
NPI:1861259624
Name:BUSSIS, ANITA B (LCPC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:BUSSIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 CHARLES VIEW WAY APT C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2121
Mailing Address - Country:US
Mailing Address - Phone:561-827-4321
Mailing Address - Fax:
Practice Address - Street 1:10711 RED RUN BLVD STE 112
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5138
Practice Address - Country:US
Practice Address - Phone:410-298-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional