Provider Demographics
NPI:1407311277
Name:ANDERSON, COTY
Entity Type:Individual
Prefix:
First Name:COTY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1971
Mailing Address - Country:US
Mailing Address - Phone:757-668-5254
Mailing Address - Fax:757-668-8873
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:757-668-5254
Practice Address - Fax:757-668-8873
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040109021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical