Basic Information
| Provider Information | |||||||||
| NPI: | 1962951335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULISH-AVERY | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | LAURA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2675 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280541478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048244999 | ||||||||
| FaxNumber: | 7048244999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275027026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9842469080 | ||||||||
| FaxNumber: | 9844642242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2016 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | NC | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 06601 | MD | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 6221 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.