Organization Name: | MARTHA L ANDERSON |
NPI Number: | 1225325624 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARTHA LEWIS ANDERSON (OWNER DIRECTOR) |
Mailing Address: | 3310 Eaglebrook Rd Christiansburg |
State: | VA US |
Postal Code: | 240738106 |
Phone Number: | 5404492593 |
Fax Number: | 5403829010 |
NPI Enumeration Date: | 07/06/2011 |
NPI Last Update Date: | 07/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701001698 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |