Provider Demographics
NPI:1205472537
Name:WHITTAKER, ANDREA DELEO (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DELEO
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 BRAKEMAN CIR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-3252
Mailing Address - Country:US
Mailing Address - Phone:706-224-2402
Mailing Address - Fax:
Practice Address - Street 1:330 RESEARCH DR STE 250
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2747
Practice Address - Country:US
Practice Address - Phone:706-224-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0066761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical