Healthcare Provider Details

I. General information

NPI: 1952532772
Provider Name (Legal Business Name): G. WILLIAM ANDERSON M.A. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 ROTCH AVE NE
MASSILLON OH
44646-4479
US

IV. Provider business mailing address

325 LAKE AVE NE
MASSILLON OH
44646-4349
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-2311
  • Fax:
Mailing address:
  • Phone: 330-830-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC0701108
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC0701108
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0701108
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberC0701108
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0701108
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberC0701108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: