| Doctor Name: | GREGORY ANDERSON |
| NPI Number: | 1457338063 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 0810001504 |
| Business Practice Address: | 45 Pine St Langley Afb, VA - 236652025 |
| Business Phone Number: | 7577646840 |
| Business Fax Number: | |
| Mailing Address: | 45 Pine St, LANGLEY AFB |
| State: | VA |
| Postal Code: | 236652025 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/23/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810001504 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |