Provider Demographics
NPI:1891842928
Name:AIDELLS, ANDREA LEE (LCSW & MFT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LEE
Last Name:AIDELLS
Suffix:
Gender:F
Credentials:LCSW & MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5625 COLLEGE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1585
Mailing Address - Country:US
Mailing Address - Phone:510-653-1903
Mailing Address - Fax:510-653-1903
Practice Address - Street 1:5625 COLLEGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1585
Practice Address - Country:US
Practice Address - Phone:510-653-1903
Practice Address - Fax:510-653-1903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS53201041C0700X
CAMFC8026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist