Provider Demographics
NPI:1326234717
Name:ANDERSON, DANA K JR (LMFT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:K
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 PINE BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7102
Mailing Address - Country:US
Mailing Address - Phone:407-444-0473
Mailing Address - Fax:
Practice Address - Street 1:2949 W STATE ROAD 434
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4458
Practice Address - Country:US
Practice Address - Phone:407-221-0366
Practice Address - Fax:310-347-4260
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0131360015Medicaid