Healthcare Provider Details

I. General information

NPI: 1518277482
Provider Name (Legal Business Name): MISTY L ANDREWS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 05/22/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SAVANNAH AVE
STATESBORO GA
30458
US

IV. Provider business mailing address

133 ROYAL OAK DR
GUYTON GA
31312-5623
US

V. Phone/Fax

Practice location:
  • Phone: 706-913-0340
  • Fax:
Mailing address:
  • Phone: 706-913-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1104
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: