Healthcare Provider Details

I. General information

NPI: 1063559862
Provider Name (Legal Business Name): NICOLE LAWANDA ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 WOODLAWN GREEN CT APT B
ALEXANDRIA VA
22309-4629
US

IV. Provider business mailing address

5808 WOODLAWN GREEN CT APT B
ALEXANDRIA VA
22309-4629
US

V. Phone/Fax

Practice location:
  • Phone: 571-241-7639
  • Fax:
Mailing address:
  • Phone: 571-241-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0701003974
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: