Provider Demographics
NPI:1336804574
Name:JOHNSON, ANDREA KATHALEEN (MA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHALEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KATHALEEN
Other - Last Name:BOND JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:13500 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-6909
Mailing Address - Country:US
Mailing Address - Phone:270-282-1878
Mailing Address - Fax:
Practice Address - Street 1:13500 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6909
Practice Address - Country:US
Practice Address - Phone:270-282-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health