Provider Demographics
NPI:1083024343
Name:CHERRY, ANDREA DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DANIELLE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 STONEHOLLOW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1789
Mailing Address - Country:US
Mailing Address - Phone:832-630-0595
Mailing Address - Fax:
Practice Address - Street 1:1210 STONEHOLLOW DR
Practice Address - Street 2:SUITE A
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1789
Practice Address - Country:US
Practice Address - Phone:832-630-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-15192103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst