Provider Demographics
NPI:1962749127
Name:MCALLISTER, ANDRE MAURICE (LCAS-A)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:MAURICE
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-2210
Mailing Address - Country:US
Mailing Address - Phone:910-654-5210
Mailing Address - Fax:
Practice Address - Street 1:512 S BROWN ST
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-2210
Practice Address - Country:US
Practice Address - Phone:910-654-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2201-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)