Provider Demographics
NPI:1861681470
Name:HARPER, ANDREA PHYLLIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:PHYLLIS
Last Name:HARPER
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 1:1809 DEWITT ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-4046
Mailing Address - Country:US
Mailing Address - Phone:850-763-3851
Mailing Address - Fax:
Practice Address - Street 1:1809 DEWITT ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-4046
Practice Address - Country:US
Practice Address - Phone:850-763-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 70961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical