Provider Demographics
NPI:1457041378
Name:ALLEN, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ANDREA ALLEN CADC, CPRC, CPSS
Mailing Address - Street 2:130 MEDICAL CENTER DR.
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117
Mailing Address - Country:US
Mailing Address - Phone:734-654-2169
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117-9461
Practice Address - Country:US
Practice Address - Phone:734-654-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)