Provider Demographics
NPI:1578653184
Name:VERMILLION-GUY, ANDREA DANELLE (CAC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DANELLE
Last Name:VERMILLION-GUY
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 EASON PL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2703
Mailing Address - Country:US
Mailing Address - Phone:318-237-0287
Mailing Address - Fax:
Practice Address - Street 1:1917 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5729
Practice Address - Country:US
Practice Address - Phone:318-538-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)