Provider Demographics
NPI:1578879664
Name:WESLEY, ANDRA LAVONNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDRA
Middle Name:LAVONNE
Last Name:WESLEY
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 1:800 E CAMPBELL RD
Mailing Address - Street 2:SUITE 246
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6706
Mailing Address - Country:US
Mailing Address - Phone:972-671-6066
Mailing Address - Fax:
Practice Address - Street 1:800 E CAMPBELL RD
Practice Address - Street 2:SUITE 246
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-6706
Practice Address - Country:US
Practice Address - Phone:972-671-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical