Healthcare Provider Details

I. General information

NPI: 1053302174
Provider Name (Legal Business Name): KATHI K ANDERSON L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BOULDERS PKWY SUITE 202
RICHMOND VA
23225
US

IV. Provider business mailing address

1000 BOULDERS PKWY SUITE 202
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-7881
  • Fax: 804-560-3474
Mailing address:
  • Phone: 804-320-7881
  • Fax: 804-560-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003594
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: