Provider Demographics
NPI:1245429745
Name:ANDREWS, PAUL VICTOR (MHS, LCADC, LPC, CCS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:VICTOR
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:MHS, LCADC, LPC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE-ON-DELAWARE
Mailing Address - State:PA
Mailing Address - Zip Code:18356-0172
Mailing Address - Country:US
Mailing Address - Phone:570-476-1902
Mailing Address - Fax:570-476-4225
Practice Address - Street 1:586 MAIN ST
Practice Address - Street 2:SUITE # 9
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2004
Practice Address - Country:US
Practice Address - Phone:570-476-1902
Practice Address - Fax:570-476-4225
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00129700101YA0400X
PAPC005016101YP2500X, 103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)