Provider Demographics
NPI:1568828093
Name:ANDES, SAMMANTHA JO (LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:SAMMANTHA
Middle Name:JO
Last Name:ANDES
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:SAMMANTHA
Other - Middle Name:JO
Other - Last Name:SCHREFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:1920 BEDFORD ST
Mailing Address - Street 2:APT 10
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2009
Mailing Address - Country:US
Mailing Address - Phone:570-809-5131
Mailing Address - Fax:
Practice Address - Street 1:1920 BEDFORD ST
Practice Address - Street 2:APT 10
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2009
Practice Address - Country:US
Practice Address - Phone:570-809-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor