Provider Demographics
NPI:1962855833
Name:WHIPPLE, ANDREA MAREN (LCPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAREN
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-5033
Mailing Address - Country:US
Mailing Address - Phone:618-213-3046
Mailing Address - Fax:618-213-3046
Practice Address - Street 1:617 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966
Practice Address - Country:US
Practice Address - Phone:618-213-3046
Practice Address - Fax:618-213-3046
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health