Provider Demographics
NPI:1700337300
Name:WESTMORELAND, ANDREA MAE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MAE
Last Name:WESTMORELAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10614 MAGNOLIA HEIGHTS CIR
Mailing Address - Street 2:APARTMENT 614
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-4104
Mailing Address - Country:US
Mailing Address - Phone:585-957-3458
Mailing Address - Fax:
Practice Address - Street 1:10614 MAGNOLIA HEIGHTS CIR
Practice Address - Street 2:APARTMENT 614
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-4104
Practice Address - Country:US
Practice Address - Phone:585-957-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30293101YA0400X
GAMSW007201104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)