Provider Demographics
NPI:1568521342
Name:FLEMING, ANDREA LAVERNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LAVERNE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WYNNTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2867
Mailing Address - Country:US
Mailing Address - Phone:706-660-9335
Mailing Address - Fax:706-660-9210
Practice Address - Street 1:1320 WYNNTON RD STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2867
Practice Address - Country:US
Practice Address - Phone:706-660-9335
Practice Address - Fax:706-660-9210
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001468103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457894AMedicaid