Healthcare Provider Details

I. General information

NPI: 1861973836
Provider Name (Legal Business Name): ANDIE LEE OLOWU LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDIE LEE SOLEMINA

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CONSTITUTION LN STE 200A
DANVERS MA
01923-3630
US

IV. Provider business mailing address

800 CUMMINGS CTR BUILDING 800 SUITE 266-T BETH ISRAEL LAHEY HEALTH BEHAVIORAL SERVICES
BEVERLY MA
01915
US

V. Phone/Fax

Practice location:
  • Phone: 978-991-1978
  • Fax:
Mailing address:
  • Phone: 978-921-1190
  • Fax: 978-922-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number218934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: