Provider Demographics
NPI:1689282626
Name:PERKINSON, ANDREA KRISTIN (LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KRISTIN
Last Name:PERKINSON
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:KRISTIN
Other - Last Name:CANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 PLOW POINT LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9591
Mailing Address - Country:US
Mailing Address - Phone:309-613-8016
Mailing Address - Fax:
Practice Address - Street 1:309 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-3280
Practice Address - Country:US
Practice Address - Phone:910-259-0668
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0147091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical