Provider Demographics
NPI:1548660277
Name:TIPPIT, ANDREA (LCAS-A, LPC-A)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TIPPIT
Suffix:
Gender:F
Credentials:LCAS-A, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 PUTTERS CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8369
Mailing Address - Country:US
Mailing Address - Phone:318-518-7598
Mailing Address - Fax:
Practice Address - Street 1:205 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8712
Practice Address - Country:US
Practice Address - Phone:910-295-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11298101YM0800X
NCLCAS-20895101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health