Provider Demographics
NPI:1548596224
Name:ANDERSON, PAULA A (LCPC, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCPC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1964
Mailing Address - Country:US
Mailing Address - Phone:301-335-6495
Mailing Address - Fax:
Practice Address - Street 1:849 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1964
Practice Address - Country:US
Practice Address - Phone:301-335-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2358101YM0800X
DCPRC13844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional