Provider Demographics
NPI:1073294484
Name:FEQUIERE-SMITH, ANDERLOVE (LPC)
Entity Type:Individual
Prefix:
First Name:ANDERLOVE
Middle Name:
Last Name:FEQUIERE-SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 STODDARD DR APT 223
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-3752
Mailing Address - Country:US
Mailing Address - Phone:515-164-4474
Mailing Address - Fax:
Practice Address - Street 1:135 STODDARD DR APT 223
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3752
Practice Address - Country:US
Practice Address - Phone:515-164-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6560101YP2500X
CT6743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional