Provider Demographics
NPI:1902310295
Name:GOCKLEY, ANDREA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GOCKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 CRESCENT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5326
Mailing Address - Country:US
Mailing Address - Phone:706-490-0810
Mailing Address - Fax:
Practice Address - Street 1:2322 CRESCENT RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-5326
Practice Address - Country:US
Practice Address - Phone:706-490-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical