Individual
MR. GREGORY ANDERSEN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA LCDP
Contact information
Practice address
350 COLUMBIA ST, WAKEFIELD, RI 02879-2494
(401) 789-0934
Mailing address
30 LAKESIDE DR, CHARLESTOWN, RI 02813-3143
(401) 789-0934
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP00478
RI
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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