Provider Demographics
NPI:1700635992
Name:ASTE-NIETO, ANDINA (LPCC)
Entity type:Individual
Prefix:
First Name:ANDINA
Middle Name:
Last Name:ASTE-NIETO
Suffix:
Gender:X
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-3514
Mailing Address - Country:US
Mailing Address - Phone:512-277-9015
Mailing Address - Fax:
Practice Address - Street 1:3424 47TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-3514
Practice Address - Country:US
Practice Address - Phone:512-277-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health