Provider Demographics
NPI:1003912593
Name:YANDOW, ANDREA J (LCMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:YANDOW
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BRULEY RD
Mailing Address - Street 2:
Mailing Address - City:ISLE LA MOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05463-9879
Mailing Address - Country:US
Mailing Address - Phone:802-928-3307
Mailing Address - Fax:
Practice Address - Street 1:107 FISHER POND RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6286
Practice Address - Country:US
Practice Address - Phone:802-524-6555
Practice Address - Fax:802-524-6562
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health