Provider Demographics
NPI:1114163177
Name:ANDERTON, ARIEL CATHERYNE
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:CATHERYNE
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 AVIGNON DR STE 5
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5157
Mailing Address - Country:US
Mailing Address - Phone:601-405-0049
Mailing Address - Fax:
Practice Address - Street 1:750 AVIGNON DR STE 5
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5157
Practice Address - Country:US
Practice Address - Phone:601-405-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health