Provider Demographics
NPI:1497579940
Name:ANDREWS, SHATAVIA NICOLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:SHATAVIA
Middle Name:NICOLE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 ARAPAHO RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-6905
Mailing Address - Country:US
Mailing Address - Phone:972-437-9950
Mailing Address - Fax:
Practice Address - Street 1:502 S OLD ORCHARD LN STE 126
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4374
Practice Address - Country:US
Practice Address - Phone:972-436-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional