Healthcare Provider Details

I. General information

NPI: 1073662011
Provider Name (Legal Business Name): COLLEEN ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN O'LEARY LPC

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 JOCKEYS RIDGE TRACE
APEX NC
27502
US

IV. Provider business mailing address

2704 JOCKEYS RIDGE TRACE
APEX NC
27502
US

V. Phone/Fax

Practice location:
  • Phone: 610-613-0270
  • Fax: 717-671-9680
Mailing address:
  • Phone: 610-613-0270
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004355
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004355
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: