Provider Demographics
NPI:1487767109
Name:LATELL, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LATELL
Suffix:
Gender:F
Credentials:
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 188
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0188
Mailing Address - Country:US
Mailing Address - Phone:804-435-7355
Mailing Address - Fax:804-435-6836
Practice Address - Street 1:25 OFFICE PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-0188
Practice Address - Country:US
Practice Address - Phone:804-435-7355
Practice Address - Fax:804-435-6836
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health