Provider Demographics
NPI:1134785223
Name:CASSIDY, ANDREA MICHELLE SCHULTZ (BA, CDCI)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE SCHULTZ
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:BA, CDCI
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5333
Mailing Address - Country:US
Mailing Address - Phone:907-729-6300
Mailing Address - Fax:
Practice Address - Street 1:4000 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5333
Practice Address - Country:US
Practice Address - Phone:907-729-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)