Provider Demographics
NPI:1043831167
Name:MORRISON, ANDREA LYNNE (CDCA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNNE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1403
Mailing Address - Country:US
Mailing Address - Phone:160-631-5509
Mailing Address - Fax:877-325-2816
Practice Address - Street 1:117 N 4TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1403
Practice Address - Country:US
Practice Address - Phone:160-631-5509
Practice Address - Fax:877-325-2816
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 175T00000X
OHCDCA.181461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000270Medicaid