Healthcare Provider Details

I. General information

NPI: 1902129174
Provider Name (Legal Business Name): STEWART LEE ANDERSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11387 COURTHOUSE ROAD
LUNENBURG VA
23952-0040
US

IV. Provider business mailing address

60 BUSH RIVER DRIVE
FARMVILLE VA
23901-0248
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-1623
  • Fax: 434-696-1753
Mailing address:
  • Phone: 434-696-1623
  • Fax: 434-392-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701004784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: