Provider Demographics
NPI:1164661880
Name:ANDERSON, DARLENE SCOTIA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:SCOTIA LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:SCOTIA LYNN
Other - Last Name:TONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPC, NCC
Mailing Address - Street 1:1770 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2712
Mailing Address - Country:US
Mailing Address - Phone:919-434-8613
Mailing Address - Fax:804-999-0700
Practice Address - Street 1:1108 E MAIN ST STE 906
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3539
Practice Address - Country:US
Practice Address - Phone:844-362-5966
Practice Address - Fax:804-999-0700
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008182101YP2500X
NC7295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104133Medicaid