Healthcare Provider Details

I. General information

NPI: 1902083314
Provider Name (Legal Business Name): ANDREA CAMILLE WEST C.A.P., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MEDICAL CENTER AVE SUITE 107
SEBRING FL
33870-5423
US

IV. Provider business mailing address

1570 LAKEVIEW DR STE 2
SEBRING FL
33870-7959
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-9280
  • Fax: 863-382-6299
Mailing address:
  • Phone: 863-207-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9206
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP2899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: