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General NPI Number Information
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NPI Number | 1811309925
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Entity Type | Organization
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Legal Business Name | KATHLEEN ANDERSON, LMHC, LLC
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 9140 GOLFSIDE DR SUITE 12N
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1881
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Country | US
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Telephone | 904-638-9140
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Fax | 904-701-6249
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Provider Business Mailing Address
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Address Line | 9140 GOLFSIDE DR SUITE 12N
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1881
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Country | US
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Telephone | 904-638-9140
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Fax | 904-701-6249
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN ANNE ANDERSON
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Credential | LMHC
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Telephone | 904-327-7192
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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 | MH4062
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License Number State | FL
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