Provider Demographics
NPI:1114073665
Name:POWELL-DAVIS, ANDREA LEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:POWELL-DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6502 BANDERA RD
Mailing Address - Street 2:209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1400
Mailing Address - Country:US
Mailing Address - Phone:210-288-9706
Mailing Address - Fax:210-647-0944
Practice Address - Street 1:6502 BANDERA RD
Practice Address - Street 2:209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1400
Practice Address - Country:US
Practice Address - Phone:210-288-9706
Practice Address - Fax:210-647-0944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61255101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional