Provider Demographics
NPI:1861368086
Name:DAVOLL, ANDREA BAKER
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BAKER
Last Name:DAVOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 S TROY CIR STE 340
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6439
Mailing Address - Country:US
Mailing Address - Phone:303-319-4530
Mailing Address - Fax:
Practice Address - Street 1:6402 S TROY CIR STE 340
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6439
Practice Address - Country:US
Practice Address - Phone:303-319-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.00000024471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical