Provider Demographics
NPI:1912711573
Name:STOCK, ANDREA (MS, PPS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STOCK
Suffix:
Gender:F
Credentials:MS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 NEPTUNE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9001
Mailing Address - Country:US
Mailing Address - Phone:530-209-3397
Mailing Address - Fax:
Practice Address - Street 1:609 S GOLD ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3110
Practice Address - Country:US
Practice Address - Phone:530-209-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool