Provider Demographics
NPI:1497879266
Name:ANDERSON, PATRICIA EVELYN (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EVELYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3248
Mailing Address - Country:US
Mailing Address - Phone:202-441-0941
Mailing Address - Fax:
Practice Address - Street 1:1238 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 401
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3248
Practice Address - Country:US
Practice Address - Phone:202-441-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC1373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional