Provider Demographics
NPI:1821507179
Name:GOURDINE, ANDREA R (PHD, MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:GOURDINE
Suffix:
Gender:F
Credentials:PHD, MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 VISION PARK BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3018
Mailing Address - Country:US
Mailing Address - Phone:832-346-8082
Mailing Address - Fax:281-962-7795
Practice Address - Street 1:128 VISION PARK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3018
Practice Address - Country:US
Practice Address - Phone:832-346-8082
Practice Address - Fax:281-962-7795
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX82127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health