Provider Demographics
NPI:1245390434
Name:PERRY, ANDREW PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:PERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 COLEMAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4043
Mailing Address - Country:US
Mailing Address - Phone:843-884-4043
Mailing Address - Fax:843-971-0406
Practice Address - Street 1:857 COLEMAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4043
Practice Address - Country:US
Practice Address - Phone:843-884-4043
Practice Address - Fax:843-971-0406
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical