Provider Demographics
NPI:1336369602
Name:CLARK, ANDREA WALSER (NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:WALSER
Last Name:CLARK
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WALSER WAY
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7341
Mailing Address - Country:US
Mailing Address - Phone:336-998-8338
Mailing Address - Fax:
Practice Address - Street 1:157 WALSER WAY
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7341
Practice Address - Country:US
Practice Address - Phone:336-998-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional