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General NPI Number Information
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NPI Number | 1225325624
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Entity Type | Organization
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Legal Business Name | MARTHA L ANDERSON
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 3310 EAGLEBROOK RD
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-8106
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Country | US
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Telephone | 540-449-2593
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Fax | 540-382-9010
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Provider Business Mailing Address
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Address Line | 3310 EAGLEBROOK DR.
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-8106
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Country | US
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Telephone | 540-449-2593
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Fax | 540-382-9010
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Authorized Official
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Title or Position | OWNER DIRECTOR
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Name | MRS. MARTHA LEWIS ANDERSON
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Credential | LPC
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Telephone | 540-449-2593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701001698
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License Number State | VA
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