Provider Demographics
NPI:1629580543
Name:MORGAN, ANDREA (COUNSELOR/PASTOR)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:COUNSELOR/PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1002
Mailing Address - Country:US
Mailing Address - Phone:757-553-8601
Mailing Address - Fax:
Practice Address - Street 1:110 E 39TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1002
Practice Address - Country:US
Practice Address - Phone:757-553-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral