Provider Demographics
NPI:1669005609
Name:ANDREWS, SERENA JADE (AMFT)
Entity Type:Individual
Prefix:MISS
First Name:SERENA
Middle Name:JADE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 E. FOOTHILL BLVD
Mailing Address - Street 2:STE A, PMB 189
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-538-8708
Mailing Address - Fax:
Practice Address - Street 1:1461 HIGUERA ST STE C
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2948
Practice Address - Country:US
Practice Address - Phone:805-242-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist