Provider Demographics
NPI:1245729623
Name:WARE-MEDINA, ANDREA (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WARE-MEDINA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 KIPLING ST UNIT 415
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6833
Mailing Address - Country:US
Mailing Address - Phone:720-739-1548
Mailing Address - Fax:
Practice Address - Street 1:4251 KIPLING ST UNIT 415
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6833
Practice Address - Country:US
Practice Address - Phone:720-739-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional