| Doctor Name: | DR. ANDREA DENICE DUDLEY |
| NPI Number: | 1245386788 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 3492 |
| Business Practice Address: | 301 J T Stites Blvd Sallisaw, OK - 749559302 |
| Business Phone Number: | 9187759150 |
| Business Fax Number: | 9187754790 |
| Mailing Address: | 704 W Chickasaw Ave, SALLISAW |
| State: | OK |
| Postal Code: | 749554224 |
| Phone Number: | 9186309729 |
| Fax Number: | 9187756165 |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 3492 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |