Provider Demographics
NPI:1609192327
Name:ST ANDRE, COLETTE CAROL (LMHC, CAP)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:CAROL
Last Name:ST ANDRE
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 NE LOBSTER RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1718
Mailing Address - Country:US
Mailing Address - Phone:772-595-3322
Mailing Address - Fax:772-595-3704
Practice Address - Street 1:4590 SELVITZ RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4801
Practice Address - Country:US
Practice Address - Phone:772-595-3322
Practice Address - Fax:772-595-3704
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health