Provider Demographics
NPI:1790250470
Name:ROY, ANDREA L (LCADC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:ROY
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:327 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508
Mailing Address - Country:US
Mailing Address - Phone:859-552-9189
Mailing Address - Fax:
Practice Address - Street 1:327 ASH STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508
Practice Address - Country:US
Practice Address - Phone:859-552-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288693101Y00000X, 101YP2500X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid