Provider Demographics
NPI:1982236998
Name:SWANSON, ANDREA LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEIGH
Other - Last Name:FORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 W PINNACLE POINTE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758
Mailing Address - Country:US
Mailing Address - Phone:515-779-8294
Mailing Address - Fax:
Practice Address - Street 1:5500 W PINNACLE POINTE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-268-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088760101YM0800X
ARP2306023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health