Provider Demographics
NPI:1558901306
Name:ANDERSON, ELAINE CHRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CHRISTINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ARENA DRIVE
Mailing Address - Street 2:SUITE 460-A
Mailing Address - City:LARGO,
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:202-439-2874
Mailing Address - Fax:301-627-0631
Practice Address - Street 1:9500 ARENA DRIVE
Practice Address - Street 2:SUITE 460-A
Practice Address - City:LARGO,
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:202-439-2874
Practice Address - Fax:301-627-0631
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor