Individual
FELICIA MARIA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
272 FOX RUN, LOGANVILLE, GA 30052
(678) 357-4502
Mailing address
272 FOX RUN, LOGANVILLE, GA 30052
(678) 357-4502
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC009136
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456789
N/A
GA
Enumeration date
06/21/2019
Last updated
06/21/2019
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