Provider Demographics
NPI:1356475743
Name:ANDERSON, ANDREA T (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:T
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28555 ORCHARD LAKE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2974
Mailing Address - Country:US
Mailing Address - Phone:248-509-4575
Mailing Address - Fax:
Practice Address - Street 1:28555 ORCHARD LAKE RD STE 230
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2974
Practice Address - Country:US
Practice Address - Phone:248-509-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2005242103TC0700X
MI6301014329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical