Provider Demographics
NPI:1467157677
Name:MCGUIRE, ANDREA DAWN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:MCGUIRE
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 1:2157 UNIVERSITY PARK DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5956
Mailing Address - Country:US
Mailing Address - Phone:517-243-9738
Mailing Address - Fax:
Practice Address - Street 1:1151 MICHIGAN AVE STE 122
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4072
Practice Address - Country:US
Practice Address - Phone:517-333-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker