Provider Demographics
NPI:1306543160
Name:FORD, ANDREA PEARL (LCASA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PEARL
Last Name:FORD
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1004
Mailing Address - Country:US
Mailing Address - Phone:910-964-0678
Mailing Address - Fax:910-401-1083
Practice Address - Street 1:109 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1703
Practice Address - Country:US
Practice Address - Phone:910-844-2267
Practice Address - Fax:910-390-4307
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-2091101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty