Provider Demographics
NPI:1386980266
Name:BOC, ANDREA K (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:BOC
Suffix:
Gender:F
Credentials:LCSW
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 1648
Mailing Address - Street 2:445 WINN WAY
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031
Mailing Address - Country:US
Mailing Address - Phone:404-294-3835
Mailing Address - Fax:
Practice Address - Street 1:3807 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4911
Practice Address - Country:US
Practice Address - Phone:404-892-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical