Provider Demographics
NPI:1467522979
Name:THORPE, ANDREA RENEE (LCSW, MAC, ICAADC,)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:THORPE
Suffix:
Gender:F
Credentials:LCSW, MAC, ICAADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 OLD BACK RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-1049
Mailing Address - Country:US
Mailing Address - Phone:623-628-0714
Mailing Address - Fax:843-297-4456
Practice Address - Street 1:640 OLD BACK RIVER ROAD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-1049
Practice Address - Country:US
Practice Address - Phone:623-628-0714
Practice Address - Fax:843-297-4456
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120641041C0700X
SC508240101YA0400X
GAC0160101YA0400X
GAMAC 508240101YA0400X
AZMAC 508240101YA0400X
GACSW0050411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z187469OtherMEDICARE - STATE AZ
AZ13376236Medicaid