Provider Demographics
NPI:1225325624
Name:MARTHA L ANDERSON
Entity Type:Organization
Organization Name:MARTHA L ANDERSON
Other - Org Name:ACFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-449-2593
Mailing Address - Street 1:3310 EAGLEBROOK DR.
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-8106
Mailing Address - Country:US
Mailing Address - Phone:540-449-2593
Mailing Address - Fax:540-382-9010
Practice Address - Street 1:3310 EAGLEBROOK RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-8106
Practice Address - Country:US
Practice Address - Phone:540-449-2593
Practice Address - Fax:540-382-9010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHA L ANDERSON, LPC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184716482Medicaid
VA1B208449OtherANTHEM
VA005408005Medicaid