Provider Demographics
NPI:1225552656
Name:GARDNER, ANDREA LEA (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S WALNUT ST STE C6
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2617
Mailing Address - Country:US
Mailing Address - Phone:207-447-1547
Mailing Address - Fax:
Practice Address - Street 1:151 S WALNUT ST STE C6
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2617
Practice Address - Country:US
Practice Address - Phone:575-527-5770
Practice Address - Fax:575-532-1928
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-107661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical