Provider Demographics
NPI:1649886573
Name:DURST, ANDREA KAY (LICSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:DURST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19821 W MCFARLANE RD
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-5032
Mailing Address - Country:US
Mailing Address - Phone:360-969-2416
Mailing Address - Fax:
Practice Address - Street 1:13126 W HWY 2
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001
Practice Address - Country:US
Practice Address - Phone:360-969-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610337981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical