Provider Demographics
NPI:1962052563
Name:HOWELL, ANDREA CHARLENE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHARLENE
Last Name:HOWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3519
Mailing Address - Country:US
Mailing Address - Phone:909-889-6519
Mailing Address - Fax:
Practice Address - Street 1:939 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3519
Practice Address - Country:US
Practice Address - Phone:909-889-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153346106H00000X
CA112031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC4499935OtherDIVER'S LICENSE