Healthcare Provider Details

I. General information

NPI: 1639181548
Provider Name (Legal Business Name): ANDREA MARIE PETROVICH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S RIDGEWOOD DR STE 7
SEBRING FL
33870-3300
US

IV. Provider business mailing address

102 S RIDGEWOOD DR STE 7
SEBRING FL
33870-3300
US

V. Phone/Fax

Practice location:
  • Phone: 863-359-9539
  • Fax:
Mailing address:
  • Phone: 863-359-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6732
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: