Provider Demographics
NPI:1639854904
Name:WATSON, ANDREW COREY (LPC, MA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:COREY
Last Name:WATSON
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:ANDREA/ANDI
Other - Middle Name:CLAIRE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, MA
Mailing Address - Street 1:626 ROPER POND CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1756
Mailing Address - Country:US
Mailing Address - Phone:803-445-4923
Mailing Address - Fax:
Practice Address - Street 1:626 ROPER POND CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-1756
Practice Address - Country:US
Practice Address - Phone:803-445-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11099101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health