Provider Demographics
NPI:1225549207
Name:EARLE, EQUILLIA ANDREA (LPC)
Entity Type:Individual
Prefix:
First Name:EQUILLIA
Middle Name:ANDREA
Last Name:EARLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 US HIGHWAY 380 STE 518
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2525
Mailing Address - Country:US
Mailing Address - Phone:817-269-6960
Mailing Address - Fax:
Practice Address - Street 1:7800 US HIGHWAY 380 STE 518
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2525
Practice Address - Country:US
Practice Address - Phone:817-269-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional