Individual
DR. ANDREA LACKOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4001 KING AVE, CORCORAN, CA 93212-9611
(559) 992-8800
Mailing address
PO BOX 8800, CORCORAN, CA 93212-8800
(559) 992-8800
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY23544
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY23544
CA LICENSE NUMBER
CA
Enumeration date
03/28/2007
Last updated
03/26/2013
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