Individual ProviderAndrea L HollisCounselorBehavioral Health & Social Service ProvidersPractice Address1420 Chaffee St Apt 154, Upland, CA 91786-5575(760) 261-0669PECOS EnrollmentBased on the most recent information from CMS, provider Andrea L Hollis does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1023585841Provider TypeIndividualFull NameHollis, Andrea LTitleMrs.CredentialMFTGenderFemaleSole ProprietorNoEnumeration Date10/30/2018Last Updated10/30/2018Contact InformationPractice LocationPractice Address1420 Chaffee St Apt 154, Upland, CA 91786-5575Phone(760) 261-0669FaxUnlisted FaxMailing LocationMailing Address13534 Ironstone Ave, Victorville, CA 92392-8823Phone(760) 261-0669FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer