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Individual
IRENE ANDERSON
Active
Individual
IRENE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LGP13368
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LGP13368
PRIVATE PAY
MD
Enumeration date
11/30/2022
Last updated
11/30/2022
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