Provider Demographics
NPI:1265202592
Name:MARTINEZ DE LOS HEROS, ANDREA (LLPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MARTINEZ DE LOS HEROS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLPC
Mailing Address - Street 1:244 MAYFAIR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3524
Mailing Address - Country:US
Mailing Address - Phone:248-961-4097
Mailing Address - Fax:
Practice Address - Street 1:2399 E WALTON BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1955
Practice Address - Country:US
Practice Address - Phone:248-475-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional