Provider Demographics
NPI:1720383037
Name:GANDY, YVONNE (LMSW, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:GANDY
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11693 LAGOON LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-4070
Mailing Address - Country:US
Mailing Address - Phone:325-253-5828
Mailing Address - Fax:
Practice Address - Street 1:11693 LAGOON LN
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-4070
Practice Address - Country:US
Practice Address - Phone:325-253-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1469101YA0400X
SC832101YA0400X
UT1320576-6008101YA0400X
TX15406101YA0400X
NE1509101YA0400X
NMCBT-2023-0661101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)