Provider Demographics
NPI:1629443031
Name:ANDREWS, CARRIE A
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:PERREAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6630 CHIMNEY ROCK
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-3898
Mailing Address - Country:US
Mailing Address - Phone:830-837-3095
Mailing Address - Fax:
Practice Address - Street 1:6630 CHIMNEY ROCK
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-3898
Practice Address - Country:US
Practice Address - Phone:830-837-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist