Provider Demographics
NPI:1790166395
Name:ABBOTT, ANDREA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEE
Other - Last Name:MCSWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, RPT-S
Mailing Address - Street 1:7489 ROCKFISH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6131
Mailing Address - Country:US
Mailing Address - Phone:727-798-7873
Mailing Address - Fax:833-260-0543
Practice Address - Street 1:7489 ROCKFISH RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6131
Practice Address - Country:US
Practice Address - Phone:727-798-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NCC1019331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty