Provider Demographics
NPI:1063250926
Name:CHRISTOPHER, ANDREA R (QMHA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17624 SE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5817
Mailing Address - Country:US
Mailing Address - Phone:503-449-1637
Mailing Address - Fax:
Practice Address - Street 1:22018 S CENTRAL POINT RD
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-8705
Practice Address - Country:US
Practice Address - Phone:503-221-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHA-R-5383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health