Provider Demographics
NPI:1407074610
Name:ANDERSON, KERRY-ANN YOLANDE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERRY-ANN
Middle Name:YOLANDE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KERRY-ANN
Other - Middle Name:YOLANDE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2388 ROCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3607
Mailing Address - Country:US
Mailing Address - Phone:770-355-8409
Mailing Address - Fax:
Practice Address - Street 1:2388 ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3607
Practice Address - Country:US
Practice Address - Phone:770-355-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 002977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical