Provider Demographics
NPI:1912632118
Name:BLOCK, ANDREA DEE (LPCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DEE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:5354 42ND ST S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4032
Practice Address - Country:US
Practice Address - Phone:701-501-8014
Practice Address - Fax:701-941-4504
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND1220-7-15-22-598101YM0800X
ND1220-7-15-22A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional