Provider Demographics
NPI:1992496319
Name:DOTSON, ANDREA FELICIA (CERTIFICATION)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:FELICIA
Last Name:DOTSON
Suffix:
Gender:F
Credentials:CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 SOUTH I-35 FRONTAGE RD
Mailing Address - Street 2:SUITE 362
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:682-710-3519
Mailing Address - Fax:
Practice Address - Street 1:551 SOUTH I-35 FRONTAGE RD
Practice Address - Street 2:SUITE 362
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664
Practice Address - Country:US
Practice Address - Phone:682-710-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16847101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor