Healthcare Provider Details

I. General information

NPI: 1841548179
Provider Name (Legal Business Name): ANNA LYNN XANDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STATE ST STE 202
ERIE PA
16507-1454
US

IV. Provider business mailing address

4610 SUNNYDALE BLVD
ERIE PA
16509-2238
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-8797
  • Fax:
Mailing address:
  • Phone: 814-450-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013215
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: