Individual
ANDREA H MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
221 RUE DE JEAN STE 126A, LAFAYETTE, LA 70508-8501
(337) 345-1305
(337) 201-9315
Mailing address
1510 CHEMIN AGREABLE RD, YOUNGSVILLE, LA 70592-6202
(337) 345-1305
(337) 201-9315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5907
LA
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
5907
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14103912
CAQH
—
01
—
5907
STATE LCSW LICENSE
LA
Enumeration date
12/18/2012
Last updated
04/05/2024
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