Provider Demographics
NPI:1013068840
Name:DEL GRANDE, ANDREA ROBERTA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ROBERTA
Last Name:DEL GRANDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-858-8170
Mailing Address - Fax:541-858-8167
Practice Address - Street 1:210 COVE RD
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-2520
Practice Address - Country:US
Practice Address - Phone:541-469-0222
Practice Address - Fax:541-469-0228
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 1328101YP2500X
ORC4401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional