Provider Demographics
NPI:1407575384
Name:ANDERSON, ASHANIECE (AAC)
Entity Type:Individual
Prefix:
First Name:ASHANIECE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6043
Mailing Address - Country:US
Mailing Address - Phone:253-867-8512
Mailing Address - Fax:
Practice Address - Street 1:917 PACIFIC AVE STE 211-214
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4446
Practice Address - Country:US
Practice Address - Phone:253-777-4772
Practice Address - Fax:253-883-3572
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUDWW790421348Medicaid