Provider Demographics
NPI:1023585841
Name:HOLLIS, ANDREA L (MFT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13534 IRONSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8823
Mailing Address - Country:US
Mailing Address - Phone:760-261-0669
Mailing Address - Fax:
Practice Address - Street 1:1420 CHAFFEE ST APT 154
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5575
Practice Address - Country:US
Practice Address - Phone:760-261-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health