Provider Demographics
NPI:1932592854
Name:CASEY, ANDREA W (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:W
Last Name:CASEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S LEROY ST
Mailing Address - Street 2:C/O HOPE COUNSELING CENTER
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 S LEROY ST
Practice Address - Street 2:C/O HOPE COUNSELING CENTER
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2637
Practice Address - Country:US
Practice Address - Phone:810-516-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical