Provider Demographics
NPI:1780148908
Name:WEAVER, ANDREA (LCMHC, NCC, LCASA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCMHC, NCC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SAM NEWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7593
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:704-321-4940
Practice Address - Street 1:855 SAM NEWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7593
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:704-321-4940
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25207101YA0400X
NC14585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)