Healthcare Provider Details

I. General information

NPI: 1629922653
Provider Name (Legal Business Name): ANDREA IVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 TORRENCE CHAPEL RD STE 205
CORNELIUS NC
28031-6875
US

IV. Provider business mailing address

21000 TORRENCE CHAPEL RD STE 205
CORNELIUS NC
28031-6875
US

V. Phone/Fax

Practice location:
  • Phone: 336-609-3220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20589A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: