Provider Demographics
NPI:1740578327
Name:ANDERSON, ANDREA L (MSAC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-1651
Mailing Address - Country:US
Mailing Address - Phone:805-339-1122
Mailing Address - Fax:
Practice Address - Street 1:800 S VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93009-1651
Practice Address - Country:US
Practice Address - Phone:805-339-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073974184Medicaid