Provider Demographics
NPI:1528214475
Name:ANDERSON, JOANNE (MSW,LGSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW,LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 LOCUST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1517
Mailing Address - Country:US
Mailing Address - Phone:304-366-4750
Mailing Address - Fax:304-366-4753
Practice Address - Street 1:1313 LOCUST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1517
Practice Address - Country:US
Practice Address - Phone:304-366-4750
Practice Address - Fax:304-366-4753
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009386481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical