Healthcare Provider Details

I. General information

NPI: 1699157727
Provider Name (Legal Business Name): RASHEDA L ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 MEMORIAL DR SUITE 110-C
DECATUR GA
30032-1504
US

IV. Provider business mailing address

16 DELIGHTED AVE
NORTH LAS VEGAS NV
89031-1393
US

V. Phone/Fax

Practice location:
  • Phone: 404-974-4820
  • Fax:
Mailing address:
  • Phone: 404-437-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP0283
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: