Provider Demographics
NPI:1750983243
Name:ENSOR, ANDREW (MSW, LSWAIC, SUDP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ENSOR
Suffix:
Gender:M
Credentials:MSW, LSWAIC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19010 68TH AVE NE UNIT C202
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2692
Mailing Address - Country:US
Mailing Address - Phone:206-947-6235
Mailing Address - Fax:
Practice Address - Street 1:19010 68TH AVE NE UNIT C202
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2692
Practice Address - Country:US
Practice Address - Phone:206-947-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61131015101YA0400X
WA610109711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)