Provider Demographics
NPI:1013585553
Name:VAN DEVENDER, ANDREW N (MSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:N
Last Name:VAN DEVENDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 COLD SPRINGS TRL SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4459
Mailing Address - Country:US
Mailing Address - Phone:770-658-4431
Mailing Address - Fax:
Practice Address - Street 1:2705 COLD SPRINGS TRL SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4459
Practice Address - Country:US
Practice Address - Phone:770-658-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker