Provider Demographics
NPI:1114063187
Name:ANDERSON, MISTI D (MS, CAP, CMHP)
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, CAP, CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9254
Mailing Address - Country:US
Mailing Address - Phone:850-689-6657
Mailing Address - Fax:
Practice Address - Street 1:502 N. FERDON BLVD.
Practice Address - Street 2:B
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536
Practice Address - Country:US
Practice Address - Phone:850-758-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3431101YA0400X
FL50228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)