Provider Demographics
NPI:1174290993
Name:ANDERSON, VIRGINIA IRENE (MA NCC LPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:IRENE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 EXETER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1723
Mailing Address - Country:US
Mailing Address - Phone:570-362-3246
Mailing Address - Fax:
Practice Address - Street 1:400 3RD AVE STE 218
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5816
Practice Address - Country:US
Practice Address - Phone:267-702-5350
Practice Address - Fax:570-714-2878
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional