Provider Demographics
NPI:1538689401
Name:ANDERSON, ROBERT MICHAEL (LPC, ACS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 GRAVES MILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5398
Mailing Address - Country:US
Mailing Address - Phone:434-239-2004
Mailing Address - Fax:434-239-2005
Practice Address - Street 1:434 GRAVES MILL RD STE 1
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5398
Practice Address - Country:US
Practice Address - Phone:434-239-2004
Practice Address - Fax:434-239-2005
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005686101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA600876772Medicaid