Provider Demographics
NPI:1467684456
Name:ANDREWS, LISA (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 PHOENIX BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5552
Mailing Address - Country:US
Mailing Address - Phone:770-997-1738
Mailing Address - Fax:770-991-1375
Practice Address - Street 1:1651 PHOENIX BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5552
Practice Address - Country:US
Practice Address - Phone:770-997-1738
Practice Address - Fax:770-991-1375
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional