Most Relevant Information
Provider Data
| NPI Number: | 1003520057 |
| Provider Name: | ANDREA BOULWARE LCMHCA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | A17684 |
Most Important Dates
| Enumeration Date: | 01/12/2023 |
| Last Updated: | 01/12/2023 |
Provider Practice Location
7300 CARMEL EXECUTIVE PARK DR STE 115
CHARLOTTE
NC
282261310
Practice Location Phone/Fax
| Phone: | 9802433646 |
| Fax: |
Provider Mailing Location
1811 SUMMIT VIEW PL
WAXHAW
NC
281737333
Provider Mailing Phone/Fax
| Phone: | 9802433646 |
| Fax: |