Provider Demographics
NPI:1184339558
Name:KILLINGSWORTH, ANDREW R (EDD, LPC-MHSP, NCC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:KILLINGSWORTH
Suffix:
Gender:M
Credentials:EDD, LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-4922
Mailing Address - Country:US
Mailing Address - Phone:615-772-4574
Mailing Address - Fax:
Practice Address - Street 1:890 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-4922
Practice Address - Country:US
Practice Address - Phone:615-772-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2077101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor