Provider Demographics
NPI:1174050371
Name:MORRIS, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 DANIELS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:338 DANIELS POINTE DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4347
Practice Address - Country:US
Practice Address - Phone:407-968-8284
Practice Address - Fax:407-968-8284
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2024-12-05
Deactivation Date:2020-11-30
Deactivation Code:
Reactivation Date:2021-05-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities