Provider Demographics
NPI:1114597325
Name:BOUND, ANDREA ANN-MARIE (LCSW-A, LCASA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANN-MARIE
Last Name:BOUND
Suffix:
Gender:F
Credentials:LCSW-A, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 PERSON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5736
Mailing Address - Country:US
Mailing Address - Phone:910-438-0939
Mailing Address - Fax:
Practice Address - Street 1:324 PERSON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5736
Practice Address - Country:US
Practice Address - Phone:910-438-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCLCAS-27253101YA0400X
NCP0162231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)