Provider Demographics
NPI:1487830998
Name:GORMAN, ANDREA WHITE (PHD, RD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:WHITE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PHD, RD, LPC
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, RD, LPC
Mailing Address - Street 1:4028 N RANIER
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-0818
Mailing Address - Country:US
Mailing Address - Phone:480-776-7805
Mailing Address - Fax:
Practice Address - Street 1:4028 N RANIER
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-0818
Practice Address - Country:US
Practice Address - Phone:480-776-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-5184T101YP2500X
MO851891133V00000X
AZ851891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional