MEDICARE: ANDERSON COUNSELING AND EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	5635	SC
2	251B00000X	Case Management Agency	5635	SC

General Provider Information

NPI Number	:	1144658535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON COUNSELING AND EDUCATION

Provider Business Mailing Address
First Line	:	2012 HIGHWAY 160 W
Second Line	:	SUITE 16
City	:	FORT MILL
State	:	SC
Zip	:	29708-8401
Country	:	US
Telephone Number	:	314-494-9104
Fax Number	:	980-355-0769

Provider Business Practice Location Address
First Line	:	2012 HIGHWAY 160 W
Second Line	:	SUITE 16
City	:	FORT MILL
State	:	SC
Zip	:	29708-8401
Country	:	US
Telephone Number	:	314-494-9104
Fax Number	:	980-355-0769

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JERLINDA JOYCE ANDERSON
Credential	:	MS
Telephone Number	:	314-494-9104

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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Directions to “ANDERSON COUNSELING AND EDUCATION ” Practice Location

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