MEDICARE: ANDREW P RADER

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	101YM0800X	Mental Health Counselor	LPC016299	GA

General Provider Information

NPI Number	:	1619828233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW P RADER

Provider Business Mailing Address
First Line	:	311 CORNELL DR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-1302
Country	:	US
Telephone Number	:	478-334-4903
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 CORNELL DR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-1302
Country	:	US
Telephone Number	:	478-334-4903
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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