Healthcare Provider Details

I. General information

NPI: 1295290922
Provider Name (Legal Business Name): ANDREW WAYNE ADDINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 ROAD 35
MADERA CA
93636-8487
US

IV. Provider business mailing address

2610 W SHAW LN STE 105
FRESNO CA
93711-2775
US

V. Phone/Fax

Practice location:
  • Phone: 559-645-0903
  • Fax:
Mailing address:
  • Phone: 559-437-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: