Provider Demographics
NPI:1003975418
Name:GAMACHE, ANDREA M (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:UHRIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 88262
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30356
Mailing Address - Country:US
Mailing Address - Phone:770-590-8257
Mailing Address - Fax:770-476-0377
Practice Address - Street 1:2400 PLEASANT HILL RD
Practice Address - Street 2:SUITE 165
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-476-1967
Practice Address - Fax:770-476-0377
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00693459AMedicaid