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General NPI Number Information
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NPI Number | 1770618068
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Entity Type | Individual
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Provider Name | THERESA ANN ANDARE PH.D. L.P.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 18471 HAGGERTY RD
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City | NORTHVILLE
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State | MI
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Zip | 48168-9575
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Country | US
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Telephone | 248-735-6719
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Fax | 248-349-8259
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 248-577-9205
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301013068
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301018761
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License Number State | MI
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