Healthcare Provider Details

I. General information

NPI: 1497370522
Provider Name (Legal Business Name): JOAN ANDERSONLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HOODRIDGE LN
MINT HILL NC
28227-9327
US

IV. Provider business mailing address

4100 HOODRIDGE LN
MINT HILL NC
28227-9327
US

V. Phone/Fax

Practice location:
  • Phone: 352-552-7897
  • Fax:
Mailing address:
  • Phone: 352-552-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. JOAN LEE ANDERSON
Title or Position: MANAGER
Credential: LCSW
Phone: 342-552-7897