Provider Demographics
NPI:1053737668
Name:MONDAY, ANDREA MICHELLE
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:MONDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TROY EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-6458
Mailing Address - Country:US
Mailing Address - Phone:706-473-3662
Mailing Address - Fax:706-749-7871
Practice Address - Street 1:105 TROY EDWARDS RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6458
Practice Address - Country:US
Practice Address - Phone:706-473-3662
Practice Address - Fax:706-749-7871
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X, 101YP1600X, 101YP2500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183238AMedicaid
GA003183238BMedicaid