Individual
MR. ANDRE L ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
4316 SUMMERCREST BLVD APT 514, ANTIOCH, TN 37013-5804
(615) 293-1864
Mailing address
PO BOX 1361, ANTIOCH, TN 37011-1361
(615) 293-1864
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1-04-1884
TN
Other
Enumeration date
02/20/2008
Last updated
02/20/2008
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