Provider Demographics
NPI:1750870408
Name:ANDREA GARRAWAY COUNSELING PLLC
Entity type:Organization
Organization Name:ANDREA GARRAWAY COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR AND PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, LCMHCS, CCS
Authorized Official - Phone:704-830-8060
Mailing Address - Street 1:4530 HUBBARD FALLS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4530 HUBBARD FALLS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2356
Practice Address - Country:US
Practice Address - Phone:704-830-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154753101Medicaid