Provider Demographics
NPI:1457580896
Name:PRITCHARD-BOONE, ANDREA LEA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEA
Last Name:PRITCHARD-BOONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:PRITCHARD-BOONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:314 S MCQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4723
Mailing Address - Country:US
Mailing Address - Phone:843-407-4440
Mailing Address - Fax:843-407-4461
Practice Address - Street 1:314 S MCQUEEN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4723
Practice Address - Country:US
Practice Address - Phone:843-407-4440
Practice Address - Fax:843-407-4461
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1122103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent