Provider Demographics
NPI:1922885235
Name:ANDREA ROOF, PSYD, PLLC
Entity Type:Organization
Organization Name:ANDREA ROOF, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-989-9070
Mailing Address - Street 1:322 S COLLEGE RD # 1098
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1632
Mailing Address - Country:US
Mailing Address - Phone:267-989-9070
Mailing Address - Fax:
Practice Address - Street 1:3609 PINE BARK CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2832
Practice Address - Country:US
Practice Address - Phone:267-989-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty