Provider Demographics
NPI:1093540452
Name:COLEY, ANDRECE
Entity type:Individual
Prefix:
First Name:ANDRECE
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14271 LANIKAI BEACH DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-8020
Mailing Address - Country:US
Mailing Address - Phone:954-254-6047
Mailing Address - Fax:
Practice Address - Street 1:3680 AVALON PARK BLVD E STE 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9372
Practice Address - Country:US
Practice Address - Phone:954-254-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker