Provider Demographics
NPI:1679946818
Name:BROADWATER, ANDREA (LMHC, CMHS, MHP, LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BROADWATER
Suffix:
Gender:X
Credentials:LMHC, CMHS, MHP, LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:PINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4518 CASHMERE DR NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-1356
Mailing Address - Country:US
Mailing Address - Phone:734-210-0308
Mailing Address - Fax:
Practice Address - Street 1:2232 S MAIN ST # 384
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6938
Practice Address - Country:US
Practice Address - Phone:734-210-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60393707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health