Provider Demographics
NPI:1497198097
Name:MUTHEMBA, ANDREW M (LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:MUTHEMBA
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 INDIGO DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3319
Mailing Address - Country:US
Mailing Address - Phone:919-971-4435
Mailing Address - Fax:
Practice Address - Street 1:103 INDIGO DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3319
Practice Address - Country:US
Practice Address - Phone:919-971-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3157101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)