Provider Demographics
NPI:1356887343
Name:ANDY
Entity type:Organization
Organization Name:ANDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:INETTA
Authorized Official - Middle Name:OETLIA
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-731-4090
Mailing Address - Street 1:2301 WORSHIP ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:SC
Mailing Address - Zip Code:29567-0092
Mailing Address - Country:US
Mailing Address - Phone:843-731-4090
Mailing Address - Fax:
Practice Address - Street 1:2301 WORSHIP ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LITTLE ROCK
Practice Address - State:SC
Practice Address - Zip Code:29567-0092
Practice Address - Country:US
Practice Address - Phone:843-731-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health