Provider Demographics
NPI:1073767455
Name:CONSTAND, ANDREA E (BA, LMBT, RMT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:E
Last Name:CONSTAND
Suffix:
Gender:F
Credentials:BA, LMBT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 PROVENCE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5095
Mailing Address - Country:US
Mailing Address - Phone:704-376-8831
Mailing Address - Fax:
Practice Address - Street 1:8812 PROVENCE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5095
Practice Address - Country:US
Practice Address - Phone:704-376-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist