Provider Demographics
NPI:1548981582
Name:COSTON, ANDREA SUE (LSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SUE
Last Name:COSTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SUE
Other - Last Name:DECKINGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:500 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1520
Mailing Address - Country:US
Mailing Address - Phone:309-826-3878
Mailing Address - Fax:704-980-3082
Practice Address - Street 1:102 E. CHESTNUT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-490-3060
Practice Address - Fax:704-980-3082
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0184101041C0700X
IL1501113701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical