Provider Demographics
NPI:1295087989
Name:SMALLS, ANDREA (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SMALLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 NATCHITOCHES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-3751
Mailing Address - Country:US
Mailing Address - Phone:318-855-8773
Mailing Address - Fax:318-855-8779
Practice Address - Street 1:407 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4107
Practice Address - Country:US
Practice Address - Phone:318-737-7407
Practice Address - Fax:318-737-7417
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024010063101YP2500X
LA3592101YP2500X
WA61503202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health