Provider Demographics
NPI:1811556053
Name:JAMES, ANDREA RAQUEL
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RAQUEL
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 GOLFBROOK CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3117
Mailing Address - Country:US
Mailing Address - Phone:678-768-4091
Mailing Address - Fax:
Practice Address - Street 1:3040 HOLCOMB BRIDGE RD STE J2
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1357
Practice Address - Country:US
Practice Address - Phone:770-696-9231
Practice Address - Fax:770-696-9231
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health