Healthcare Provider Details

I. General information

NPI: 1104892330
Provider Name (Legal Business Name): THOMAS LEE ANDERSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 HAMPTON PARKWAY OFFICE OF THE COMMAND PSYCHOLOGIST
FT. JACKSON SC
20207
US

IV. Provider business mailing address

10000 HAMPTON PARKWAY OFFICE OF THE COMMAND PSYCHOLOGIST
FT. JACKSON SC
20207
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-8794
  • Fax:
Mailing address:
  • Phone: 803-751-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number386
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: