Healthcare Provider Details

I. General information

NPI: 1649144262
Provider Name (Legal Business Name): ANDREW GEDGOUDAS LMFT-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BEECH ST
NEWLAND NC
28657-9670
US

IV. Provider business mailing address

360 BEECH ST
NEWLAND NC
28657-9670
US

V. Phone/Fax

Practice location:
  • Phone: 828-733-5889
  • Fax:
Mailing address:
  • Phone: 205-447-5684
  • Fax: 205-447-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20788A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: