Provider Demographics
NPI:1902645351
Name:CLOUSE, ANDREW CHRISTOPHER (LCMHCA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:CLOUSE
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:CLOUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:705 E 1ST ST APT 11
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-2003
Mailing Address - Country:US
Mailing Address - Phone:336-480-7038
Mailing Address - Fax:
Practice Address - Street 1:231 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5029
Practice Address - Country:US
Practice Address - Phone:252-321-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health