Provider Demographics
NPI:1003527367
Name:SMITH, ANDREA (LPC-A)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121835
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-7835
Mailing Address - Country:US
Mailing Address - Phone:855-579-5323
Mailing Address - Fax:
Practice Address - Street 1:1523 W LINGLEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1821
Practice Address - Country:US
Practice Address - Phone:855-579-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86569101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor