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General NPI Number Information
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NPI Number | 1881736304
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Entity Type | Individual
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Provider Name | CARLA SUE ANDERSON MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 1778 CENTURY BLVD NE SUITE A
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City | ATLANTA
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State | GA
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Zip | 30345-3398
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Country | US
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Telephone | 404-570-3764
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Fax |
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Provider Business Mailing Address
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Address Line | 208 QUAIL RUN
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City | ROSWELL
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State | GA
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Zip | 30076-3180
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Country | US
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Telephone | 404-570-3764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002385
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License Number State | GA
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