Individual
ANDREA STREETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
439 WATSON BAY, STONE MOUNTAIN, GA 30087-6195
(770) 465-6858
Mailing address
439 WATSON BAY, STONE MOUNTAIN, GA 30087-6195
(770) 465-6858
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
044016471
GA
Other
Enumeration date
09/17/2015
Last updated
09/17/2015
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