Provider Demographics
NPI:1598230922
Name:PETRUS, ANDREA Z
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:Z
Last Name:PETRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5467
Mailing Address - Country:US
Mailing Address - Phone:762-675-0075
Mailing Address - Fax:
Practice Address - Street 1:390 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5467
Practice Address - Country:US
Practice Address - Phone:762-675-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherNOT APPLICABLE - DO NOT HAVE ANY NUMBERS