Provider Demographics
NPI:1083589352
Name:LIGONDE, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:LIGONDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 E FOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7725
Mailing Address - Country:US
Mailing Address - Phone:704-858-0381
Mailing Address - Fax:
Practice Address - Street 1:2124 CROWN CENTRE DR STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7804
Practice Address - Country:US
Practice Address - Phone:704-849-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10685101YM0800X
NCA22121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health