Provider Demographics
NPI:1558773697
Name:MABRY, ANDREANA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREANA
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANDREANA
Other - Middle Name:
Other - Last Name:ARSENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9431 HAVEN AVE STE 229
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5848
Mailing Address - Country:US
Mailing Address - Phone:909-402-2535
Mailing Address - Fax:
Practice Address - Street 1:10601 CIVIC CENTER DR STE 100BC
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3878
Practice Address - Country:US
Practice Address - Phone:909-644-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist