Basic Information
| Provider Information | |||||||||
| NPI: | 1548660277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIPPIT | ||||||||
| FirstName: | ANDREA | ||||||||
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| Credential: | LCAS-A, LPC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1979 PUTTERS CIR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273328369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185187598 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102956853 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A11298 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | LCAS-20895 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.