Provider Demographics
NPI:1023414752
Name:SARGENT, ANDREA M (LPCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:COURIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 E BAGLEY RD
Mailing Address - Street 2:SUITE105
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 N CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-3838
Practice Address - Country:US
Practice Address - Phone:330-733-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1300692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional