Provider Demographics
NPI:1326729906
Name:ANDERSON, BETHANY PAIGE (LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:PAIGE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:PAIGE
Other - Last Name:GUTHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2416 JEFFERSON AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7224
Mailing Address - Country:US
Mailing Address - Phone:443-802-5918
Mailing Address - Fax:
Practice Address - Street 1:5540 FALMOUTH ST STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1800
Practice Address - Country:US
Practice Address - Phone:804-665-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health