Healthcare Provider Details

I. General information

NPI: 1669005757
Provider Name (Legal Business Name): ANDREW ANDERSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 LIBBIE AVE STE 101
RICHMOND VA
23226-1838
US

IV. Provider business mailing address

219 E BANK ST APT 211
PETERSBURG VA
23803-3420
US

V. Phone/Fax

Practice location:
  • Phone: 804-665-4681
  • Fax:
Mailing address:
  • Phone: 704-277-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701008769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: