Provider Demographics
NPI:1396355038
Name:WATERS, ANDREW EMORY (LPCC, LMHC, LADC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:EMORY
Last Name:WATERS
Suffix:
Gender:M
Credentials:LPCC, LMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6375 NW 77TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2405
Mailing Address - Country:US
Mailing Address - Phone:845-729-9157
Mailing Address - Fax:
Practice Address - Street 1:2200 1ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3401
Practice Address - Country:US
Practice Address - Phone:612-767-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304111101YA0400X
MNCC02151101YM0800X
FLMH18040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)