Individual
MR. GLEN WAYNE ANDERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.A.
Contact information
Practice address
1650 GREENFIELD ST, WILMINGTON, NC 28401-6456
(910) 798-3500
(910) 798-7834
Mailing address
1650 GREENFIELD ST, WILMINGTON, NC 28401-6456
(910) 798-3500
(910) 798-7834
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2159
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046AE
BLUE CROSS BLUE SHIELD
NC
05
—
6107247
—
NC
Enumeration date
03/28/2007
Last updated
03/16/2020
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