MEDICARE: MRS. DONNA ANDERSON ST.CLAIR MA, MFT

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	101YM0800X	Mental Health Counselor	MFC27010	CA

General Provider Information

NPI Number	:	1982741062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA ANDERSON ST.CLAIR MA, MFT

Provider Business Mailing Address
First Line	:	3549 CARLETON STREET
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2526
Country	:	US
Telephone Number	:	619-223-1802
Fax Number	:	619-223-1802

Provider Business Practice Location Address
First Line	:	4305 GESNER ST
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6639
Country	:	US
Telephone Number	:	858-494-9597
Fax Number	:	619-223-1802

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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