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General NPI Number Information
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NPI Number | 1467323592
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Entity Type | Organization
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Legal Business Name | SOUTHERN ANGELS COMPREHENSIVE SUPPORT GROUP LLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 4243 LEBANON PIKE STE C
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City | HERMITAGE
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State | TN
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Zip | 37076-2170
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Country | US
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Telephone | 615-600-5107
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Fax |
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Provider Business Mailing Address
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Address Line | 4243 LEBANON PIKE STE C
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City | HERMITAGE
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State | TN
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Zip | 37076-2169
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Country | US
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Telephone | 615-600-5107
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Fax |
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Authorized Official
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Title or Position | OWENER/CEO
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Name | DR. VANNA M. ANDERSON
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Credential |
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Telephone | 615-657-9123
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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