Provider Demographics
NPI:1972049542
Name:COX, ANDREA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 HIGHWAY 1 S STE B
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9460
Mailing Address - Country:US
Mailing Address - Phone:803-708-0902
Mailing Address - Fax:803-403-8965
Practice Address - Street 1:1443 HIGHWAY 1 S STE B
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9460
Practice Address - Country:US
Practice Address - Phone:803-708-0902
Practice Address - Fax:803-403-8965
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional