Individual
DR. CONRAD ASHTON ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W., PH.D.
Contact information
Practice address
1636 POPPS FERRY RD, SUITE 215, BILOXI, MS 39532-2217
(228) 365-3552
(228) 392-9743
Mailing address
739 BUDDELIA CV, BILOXI, MS 39532-4118
(228) 365-3552
(228) 392-9743
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L.C.S.W. C#3822
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030389866
TRICARE
—
01
—
06656046
MS MEDICAID PROVIDER # 06656046
MS
01
—
302I803223
MEDICARE PTAN
MS
Enumeration date
09/29/2006
Last updated
02/15/2014
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