Provider Demographics
NPI:1003693409
Name:ABBOTT, ANDREA KRISTEN (RBT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KRISTEN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 E BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3218
Mailing Address - Country:US
Mailing Address - Phone:540-435-3507
Mailing Address - Fax:
Practice Address - Street 1:115 W NASHVILLE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1284
Practice Address - Country:US
Practice Address - Phone:919-375-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-24-74745103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst