Individual
MR. ANDRE L STICKNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC
Contact information
Practice address
1601 E 4TH PLAIN BLVD, BLDG 17 STE B222, VANCOUVER, WA 98661-3753
(390) 397-8484
(360) 397-8494
Mailing address
PO BOX 1845, VANCOUVER, WA 98668-1845
(390) 397-8484
(360) 397-8494
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CG60410111
WA
103K00000X
Behavior Analyst
103K00000X
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
01
—
R0000WDBCH
MEDICARE GROUP
—
Enumeration date
04/18/2012
Last updated
05/14/2014
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