Provider Information for 1093208803
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ANDREA H DRAKE LCSW
Sex: Female
NPI: 1093208803
Last Updated: 2022-05-24
Certification Date: 2022-05-24
Certification Date: 2022-05-24
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1093208803 | ||||||||||||||
| Enumeration Date | 2018-06-07 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 190 E BANNOCK ST BOISE, ID 83712-6241 United States Phone: | Fax: | ||||||||||||||
| Primary Practice Address | 1075 E PARK BLVD BOISE, ID 83712-7722 United States Phone: 208-381-5970 | Fax: | ||||||||||||||
| Secondary Practice Address(es) | 1019 W SANETTA ST | ||||||||||||||
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