Provider Demographics
NPI:1396088662
Name:MILES, ANDREA JEAN (MAPC, NCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:MILES
Suffix:
Gender:F
Credentials:MAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 CLEMMONS RD STE 20
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9394
Mailing Address - Country:US
Mailing Address - Phone:336-283-2510
Mailing Address - Fax:
Practice Address - Street 1:3540 CLEMMONS RD STE 20
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9394
Practice Address - Country:US
Practice Address - Phone:336-283-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 101YM0800X
NC14566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health