Provider Demographics
NPI:1568499796
Name:ANDEREGG, MARK WINSTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WINSTON
Last Name:ANDEREGG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13726 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6403
Mailing Address - Country:US
Mailing Address - Phone:804-739-1130
Mailing Address - Fax:804-541-6708
Practice Address - Street 1:214 BUSH RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-392-3187
Practice Address - Fax:434-392-5789
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040019591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical