Provider Demographics
NPI:1275584559
Name:ANDREWS, AZONDA E
Entity Type:Individual
Prefix:
First Name:AZONDA
Middle Name:E
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 E 21ST ST
Mailing Address - Street 2:18
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1802
Mailing Address - Country:US
Mailing Address - Phone:317-525-3597
Mailing Address - Fax:
Practice Address - Street 1:10026 E 21ST ST OFC 318
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-1802
Practice Address - Country:US
Practice Address - Phone:317-525-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN150074Medicare ID - Type Unspecified