Provider Demographics
NPI:1902391154
Name:NYLAND, ANDREA LYNN (LCDC-III)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:NYLAND
Suffix:
Gender:F
Credentials:LCDC-III
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:BURSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC-III
Mailing Address - Street 1:1815 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7000
Mailing Address - Country:US
Mailing Address - Phone:855-747-4673
Mailing Address - Fax:
Practice Address - Street 1:1815 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7000
Practice Address - Country:US
Practice Address - Phone:855-747-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161816101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0327121Medicaid