Provider Demographics
NPI:1760247225
Name:JUCK, ANDREA MARIE (MSW INTERN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:JUCK
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:JUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR-ADDICTION
Mailing Address - Street 1:5 MAREBLU STE 250
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3014
Mailing Address - Country:US
Mailing Address - Phone:949-643-6930
Mailing Address - Fax:
Practice Address - Street 1:5 MAREBLU STE 250
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3014
Practice Address - Country:US
Practice Address - Phone:949-643-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)