Provider Demographics
NPI:1619353539
Name:CARRINGTON, ANDRE JOHN
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:JOHN
Last Name:CARRINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25054 CRIMSON LASSO DR
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7614
Mailing Address - Country:US
Mailing Address - Phone:951-202-0154
Mailing Address - Fax:
Practice Address - Street 1:24885 WHITEWOOD RD STE 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2004
Practice Address - Country:US
Practice Address - Phone:951-202-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist