Provider Demographics
NPI:1154557437
Name:IRWIN, ANDREA GABRIELLE (LMHC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GABRIELLE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134A 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4528
Mailing Address - Country:US
Mailing Address - Phone:352-871-2161
Mailing Address - Fax:
Practice Address - Street 1:502 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3634
Practice Address - Country:US
Practice Address - Phone:217-373-2428
Practice Address - Fax:217-373-2445
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health