Provider Demographics
NPI:1073020491
Name:WHITTEN, ANDREA DENICE GREGG (LPC-S)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENICE GREGG
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 WATERMELON RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5252
Mailing Address - Country:US
Mailing Address - Phone:205-454-1897
Mailing Address - Fax:
Practice Address - Street 1:4124 WATERMELON RD STE B
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5252
Practice Address - Country:US
Practice Address - Phone:205-454-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL03856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty