Provider Demographics
NPI:1548962491
Name:ANDRE, STEPHANIE WRIGHT (LAC, LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WRIGHT
Last Name:ANDRE
Suffix:
Gender:F
Credentials:LAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 SUNROSE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2736
Mailing Address - Country:US
Mailing Address - Phone:949-500-6412
Mailing Address - Fax:
Practice Address - Street 1:7512 SUNROSE DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2736
Practice Address - Country:US
Practice Address - Phone:949-500-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-19736101YM0800X
NMCTB-2023-0238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health