Provider Demographics
NPI:1588994883
Name:COOLEY, ANDREA JEAN (MA LPC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:JEAN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10 W SQUARE LAKE RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0465
Mailing Address - Country:US
Mailing Address - Phone:248-990-0140
Mailing Address - Fax:888-510-9669
Practice Address - Street 1:10 W SQUARE LAKE RD
Practice Address - Street 2:SUITE 221
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0465
Practice Address - Country:US
Practice Address - Phone:248-990-0140
Practice Address - Fax:888-510-9669
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional