Provider Demographics
NPI:1518655349
Name:HARVEY, ANDREA DIANA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DIANA
Last Name:HARVEY
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 1:1950 ROSWELL RD APT 14C08
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5081
Mailing Address - Country:US
Mailing Address - Phone:912-318-1802
Mailing Address - Fax:
Practice Address - Street 1:1950 ROSWELL RD APT C08
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-3060
Practice Address - Country:US
Practice Address - Phone:912-318-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician