Healthcare Provider Details

I. General information

NPI: 1205596772
Provider Name (Legal Business Name): ERICA VARNER-ANDERSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E GREENWAY PKWY UNIT 150
SCOTTSDALE AZ
85254-2045
US

IV. Provider business mailing address

5115 N DYSART RD SUITE 202 #228
LITCHFIELD PARK AZ
85340
US

V. Phone/Fax

Practice location:
  • Phone: 480-757-4506
  • Fax:
Mailing address:
  • Phone: 912-224-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-22690
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLAMFT-10870
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: