Provider Demographics
NPI:1376995308
Name:ANDREWS, CAROL SUSAN (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUSAN
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SILVER EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-1012
Mailing Address - Country:US
Mailing Address - Phone:707-761-1153
Mailing Address - Fax:
Practice Address - Street 1:419 ELIZABETH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4602
Practice Address - Country:US
Practice Address - Phone:707-761-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53807101YM0800X, 106H00000X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAO053969OtherKAISER NUID