Petrovich, Andrea

Petrovich, Andrea is an individual health care provider with primary practice located at 107 Woodbine Place #775, Longview TX 75608. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Petrovich, Andrea can be contacted via phone (903) 757-8194.

Contact Information

Primary practice address
107 Woodbine Place #775 Longview TX 75608
Phone: (903) 757-8194
Fax: (903) 757-8294
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH6732 Florida
Behavioral Health & Social Service Providers / Professional 101YP2500X 66633-TX Texas

Profile Details

NPI number 1639181548
LBN Legal business name Petrovich, Andrea
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2006
Last updated Oct 4th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639181548 NPPES
Florida MEDICAID 761879400

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