Individual
MS. CARRIE J ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LCPC
Contact information
Practice address
702 W CHESTNUT ST, BLOOMINGTON, IL 61701-2814
(309) 827-6026
Mailing address
702 W CHESTNUT ST, BLOOMINGTON, IL 61701-2814
(309) 827-6026
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180.004675
IL
101YM0800X
Mental Health Counselor
Primary
180.004675
IL
101YP2500X
Professional Counselor
180-004675
IL
Other
Enumeration date
03/12/2007
Last updated
11/13/2023
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