Individual
ELLEN G ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISAC
Contact information
Practice address
457 CARLISLE DR, HERNDON, VA 20170-4819
(703) 464-5122
Mailing address
457 CARLISLE DR, HERNDON, VA 20170-4819
(703) 464-5122
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC0296
AZ
Other
Enumeration date
03/12/2009
Last updated
03/12/2009
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