Provider Demographics
NPI:1083824429
Name:AVILA, ANDREA YVETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:YVETTE
Last Name:AVILA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 N MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3347
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1225
Practice Address - Street 1:7130 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3347
Practice Address - Country:US
Practice Address - Phone:559-326-1222
Practice Address - Fax:559-326-1225
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6400101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty