Healthcare Provider Details

I. General information

NPI: 1699144329
Provider Name (Legal Business Name): ANDREA M DANDA LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E LAKE ST
MINNEAPOLIS MN
55407-1617
US

IV. Provider business mailing address

1000 E LAKE ST
MINNEAPOLIS MN
55407-1617
US

V. Phone/Fax

Practice location:
  • Phone: 612-827-7181
  • Fax: 612-767-4545
Mailing address:
  • Phone: 612-827-7181
  • Fax: 612-767-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5778
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: