Andrea Y Stallworth, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

106 S Lincolnway Ste E
North Aurora, IL 60542-1597

Phone

(630) 624-6561

NPI assigned

Sep 21, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1487325460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 AZALEA DR APT 1424",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601732194",
            "telephone_number": "630-624-6561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S LINCOLNWAY STE E",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605421597",
            "telephone_number": "630-624-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "ANDREA",
        "middle_name": "Y",
        "credential": "NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.takingcontrolcounseling.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "address_1": "106 S Lincolnway Ste E",
            "city": "North Aurora",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605421597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in North Aurora, IL
• Providers in North Aurora, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.