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General NPI Number Information
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NPI Number | 1912992777
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Entity Type | Individual
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Provider Name | ROBERT J. ANDERSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 3205 RANDALL PKWY STE 105
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City | WILMINGTON
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State | NC
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Zip | 28403-2565
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Country | US
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Telephone | 910-742-9243
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Fax | 888-746-1787
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Provider Business Mailing Address
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Address Line | PO BOX 538622
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City | ATLANTA
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State | GA
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Zip | 30353-8622
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Country | US
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Telephone | 910-794-4521
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Fax | 877-364-7056
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1891
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License Number State | NC
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Taxonomy #2
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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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