MEDICARE: ANDREA ADDIE LCSW, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	66596	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15003	TX

General Provider Information

NPI Number	:	1538797501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ADDIE LCSW, LCDC

Provider Business Mailing Address
First Line	:	2323 S VOSS RD STE 125I
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3867
Country	:	US
Telephone Number	:	281-346-3087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 S VOSS RD STE 125I
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3867
Country	:	US
Telephone Number	:	281-346-3087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	10/29/2022

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