Provider Demographics
NPI:1851870349
Name:THOMAS, ANDREA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 W WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9605
Mailing Address - Country:US
Mailing Address - Phone:602-291-3966
Mailing Address - Fax:
Practice Address - Street 1:2345 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7848
Practice Address - Country:US
Practice Address - Phone:602-394-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health