Provider Demographics
NPI:1194058867
Name:COLLURA, ANDREA DYAL (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DYAL
Last Name:COLLURA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ELM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2049
Mailing Address - Country:US
Mailing Address - Phone:860-338-1166
Mailing Address - Fax:
Practice Address - Street 1:2934 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1027
Practice Address - Country:US
Practice Address - Phone:860-338-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional