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General NPI Number Information
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NPI Number | 1497579940
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Entity Type | Individual
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Provider Name | SHATAVIA NICOLE ANDREWS MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 502 S OLD ORCHARD LN STE 126
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City | LEWISVILLE
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State | TX
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Zip | 75067-4374
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Country | US
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Telephone | 972-436-7962
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Fax |
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Provider Business Mailing Address
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Address Line | 5402 ARAPAHO RD
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City | DALLAS
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State | TX
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Zip | 75248-6905
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Country | US
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Telephone | 972-437-9950
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 91023
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License Number State | TX
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