Provider Demographics
NPI:1407360423
Name:KROMMINGA, ANDREA JANE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JANE
Last Name:KROMMINGA
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 1:319 CREEKSIDE DR APT B
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5957
Mailing Address - Country:US
Mailing Address - Phone:229-894-8591
Mailing Address - Fax:
Practice Address - Street 1:601 11TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1645
Practice Address - Country:US
Practice Address - Phone:229-430-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
GALPC012780101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171W00000XOther Service ProvidersContractor