Provider Demographics
NPI:1639947179
Name:ANDREWS, SALLY ANN (LCADC, LAC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LCADC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 E MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2319
Mailing Address - Country:US
Mailing Address - Phone:908-923-3969
Mailing Address - Fax:
Practice Address - Street 1:92 E MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2319
Practice Address - Country:US
Practice Address - Phone:908-923-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00518900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health