Provider Demographics
NPI:1215307038
Name:ROBERTSON, ANDREA MARIE (RADT1)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7512
Mailing Address - Country:US
Mailing Address - Phone:707-552-5295
Mailing Address - Fax:707-553-3394
Practice Address - Street 1:1149 WARREN AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7512
Practice Address - Country:US
Practice Address - Phone:707-552-5295
Practice Address - Fax:707-553-3394
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1213950915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor