Healthcare Provider Details

I. General information

NPI: 1316552938
Provider Name (Legal Business Name): AARON ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N COURTHOUSE RD
NORTH CHESTERFIELD VA
23236-4045
US

IV. Provider business mailing address

707 N COURTHOUSE RD
NORTH CHESTERFIELD VA
23236-4045
US

V. Phone/Fax

Practice location:
  • Phone: 804-924-2236
  • Fax: 866-626-4469
Mailing address:
  • Phone: 804-924-2236
  • Fax: 866-626-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009828
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: