Provider Demographics
NPI:1457566945
Name:ANDUIZA, LOURDES MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:MARIA
Last Name:ANDUIZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E TREMONT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5364
Mailing Address - Country:US
Mailing Address - Phone:980-216-4894
Mailing Address - Fax:
Practice Address - Street 1:218 E TREMONT AVE STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5364
Practice Address - Country:US
Practice Address - Phone:980-216-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0102681041C0700X
NY0669231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical