Provider Demographics
NPI:1043840291
Name:ANDERSON, CHARITY MICHAL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:MICHAL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CHARITY
Other - Middle Name:MICHAL
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:200 RAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5639
Mailing Address - Country:US
Mailing Address - Phone:903-707-1751
Mailing Address - Fax:
Practice Address - Street 1:200 RAWLEY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5639
Practice Address - Country:US
Practice Address - Phone:903-707-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82949101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health