Provider Demographics
NPI:1770238354
Name:ANDRIES, JENNIE CARRA (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:CARRA
Last Name:ANDRIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 MAIN ST STE A188
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4083
Mailing Address - Country:US
Mailing Address - Phone:225-242-9220
Mailing Address - Fax:
Practice Address - Street 1:7620 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7622
Practice Address - Country:US
Practice Address - Phone:225-242-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15976104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker