Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00129700 | NJ |
Y | 101YP2500X | Professional Counselor | PC005016 | PA |
N | 102L00000X | Psychologist | PC005016 | PA |
N | 103T00000X | Psychologist | PC005016 | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PC005016 | PA |
NPI | 1245429745 |
---|---|
Provider Name | Mr. Paul Victor Andrews |
First Address | Shawnee-On-Delaware, PA 18356-0172 |
Second Address | Stroudsburg, PA 18360-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2007 |
Last Update Date | 25/01/2010 |