Provider Demographics
NPI:1396860946
Name:GELSTHORPE, ANDREA LYNN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:LYNN
Last Name:GELSTHORPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CDSA OF THE BLUE RIDGE
Mailing Address - Street 2:2359 HWY.105
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-265-5391
Mailing Address - Fax:828-265-5394
Practice Address - Street 1:CDSA OF THE BLUE RIDGE
Practice Address - Street 2:2359 HWY. 105
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-265-5391
Practice Address - Fax:828-265-5394
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1384UOtherBLUE CROSS BLUE SHIELD