MEDICARE: MS. ADRIENNE LYNN ANDERSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0730000429	VA

General Provider Information

NPI Number	:	1811201791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADRIENNE LYNN ANDERSON PHD

Provider Business Mailing Address
First Line	:	835 3RD AVE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-1352
Country	:	US
Telephone Number	:	619-427-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S WHITING ST STE 106
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-3416
Country	:	US
Telephone Number	:	571-257-8634
Fax Number	:	571-921-4304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	03/25/2020

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