Individual
MRS. AUDREY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC LCADC
Contact information
Practice address
47 MILLER STREET 2ND FLOOR, NEWARK, NJ 07114-1750
(973) 596-4190
(973) 639-6583
Mailing address
590 NORTH 7TH STREET, NEWARK, NJ 07107
(800) 227-7705
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
37AC00551600
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00334900
NJ
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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