Provider Demographics
NPI:1841055936
Name:LOVAN, ANDRE (SUDRC)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:LOVAN
Suffix:
Gender:M
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 GRIFFEY WAY
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3065
Mailing Address - Country:US
Mailing Address - Phone:916-612-2452
Mailing Address - Fax:
Practice Address - Street 1:750 SPAANS DR STE F
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8609
Practice Address - Country:US
Practice Address - Phone:209-744-9099
Practice Address - Fax:209-744-9910
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)