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General NPI Number Information
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NPI Number | 1144713454
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Entity Type | Individual
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Provider Name | ANDREA CARTER WOLVERTON LMFT, CADC II
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 231 SUNNYSIDE RD
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City | THOMASTON
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State | GA
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Zip | 30286-7442
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Country | US
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Telephone | 706-665-6998
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Fax |
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Provider Business Mailing Address
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Address Line | 231 SUNNYSIDE RD
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City | THOMASTON
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State | GA
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Zip | 30286-7442
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Country | US
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Telephone | 706-665-6998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1180
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001628
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License Number State | GA
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