Provider Demographics
NPI:1104549369
Name:ARROYO DURAN, ANDREA ALANIS
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALANIS
Last Name:ARROYO DURAN
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 1:6020 DAWSON BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1259
Mailing Address - Country:US
Mailing Address - Phone:770-662-0249
Mailing Address - Fax:
Practice Address - Street 1:6020 DAWSON BLVD STE I
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1259
Practice Address - Country:US
Practice Address - Phone:770-662-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APC008665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health