Provider Demographics
NPI:1316552938
Name:ANDERSON, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4045
Mailing Address - Country:US
Mailing Address - Phone:804-924-2236
Mailing Address - Fax:866-626-4469
Practice Address - Street 1:707 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4045
Practice Address - Country:US
Practice Address - Phone:804-924-2236
Practice Address - Fax:866-626-4469
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty