Provider Demographics
NPI:1316358534
Name:ANDREWS, MARK (BA CADC-1)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:BA CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29821 COLVIN ST.
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444
Mailing Address - Country:US
Mailing Address - Phone:541-247-4082
Mailing Address - Fax:541-247-4082
Practice Address - Street 1:94235 MOORE ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-9699
Practice Address - Country:US
Practice Address - Phone:541-247-4082
Practice Address - Fax:541-247-4082
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-06-04101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)