Healthcare Provider Details

I. General information

NPI: 1235046095
Provider Name (Legal Business Name): ASHANTI ANDERSON LAPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHAN ANDERSON LAPC

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 CHIMNEY SWIFT DR
HUNTINGDON VALLEY PA
19006-3302
US

IV. Provider business mailing address

3005 GRAYS FERRY AVE UNIT 3947
PHILADELPHIA PA
19146-5306
US

V. Phone/Fax

Practice location:
  • Phone: 267-708-6932
  • Fax: 445-777-7807
Mailing address:
  • Phone: 267-708-6932
  • Fax: 445-777-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002753
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: