Provider Demographics
NPI:1790053320
Name:PAYNE, ANDREA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:PAYNE
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 1:7600 WOOD HOLLOW DR
Mailing Address - Street 2:APT 1209
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2285
Mailing Address - Country:US
Mailing Address - Phone:512-851-3740
Mailing Address - Fax:
Practice Address - Street 1:7600 WOOD HOLLOW DR
Practice Address - Street 2:APT 1209
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2285
Practice Address - Country:US
Practice Address - Phone:512-851-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical