Provider Demographics
NPI:1497756464
Name:VOGEL, ANDREA TERRI (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:TERRI
Last Name:VOGEL
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 1:1104 W 4TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3847
Mailing Address - Country:US
Mailing Address - Phone:423-317-8482
Mailing Address - Fax:423-317-9901
Practice Address - Street 1:1104 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3847
Practice Address - Country:US
Practice Address - Phone:423-317-8482
Practice Address - Fax:423-317-9901
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4054395OtherBLUE CROSS
TN3696675Medicaid
TN3696675Medicare ID - Type Unspecified