Provider Demographics
NPI:1649354945
Name:WEST, ANDREW PAUL (MA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:WEST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 VINEHAVEN DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2439
Mailing Address - Country:US
Mailing Address - Phone:704-918-1343
Mailing Address - Fax:704-461-4334
Practice Address - Street 1:1025 VINEHAVEN DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2439
Practice Address - Country:US
Practice Address - Phone:704-918-1343
Practice Address - Fax:704-461-4334
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7169101YP2500X
NC(NC)7169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC563646OtherVALUE OPTIONS
NC6104180Medicaid
NC152NNOtherBLUE CROSS BLUE SHIELD