Provider Demographics
NPI:1528187150
Name:ANDERSON, CHRISTY K (LAC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 SAINT GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:ND
Mailing Address - Zip Code:58564-4103
Mailing Address - Country:US
Mailing Address - Phone:701-597-3419
Mailing Address - Fax:
Practice Address - Street 1:7785 SAINT GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:ND
Practice Address - Zip Code:58564-4103
Practice Address - Country:US
Practice Address - Phone:701-597-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND75000Medicaid
ND027593OtherBLUE CROSS BLUE SHIELD