Individual
MARK R. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
324 E SAINT JOHN ST, SPARTANBURG, SC 29302-1505
(864) 707-1953
Mailing address
45 WOODWIND DR, SPARTANBURG, SC 29302-4517
(864) 707-1953
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
5246
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
03/11/2008
Last updated
09/09/2016
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