Individual
MR. MARK SHANE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RAC, CCDP, CCGC
Contact information
Practice address
4105 KIRKMAN ST, LAKE CHARLES, LA 70607-4603
(337) 475-8738
(337) 475-8054
Mailing address
811 FALL ST, LAKE CHARLES, LA 70601-8659
(337) 433-4475
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2251 CIT
LA
Other
Enumeration date
05/30/2007
Last updated
09/23/2011
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