Provider Demographics
NPI:1568598621
Name:ANDERSON, ELIZABETH P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4827 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1864
Mailing Address - Country:US
Mailing Address - Phone:703-941-8089
Mailing Address - Fax:703-941-8089
Practice Address - Street 1:316 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2802
Practice Address - Country:US
Practice Address - Phone:703-549-9554
Practice Address - Fax:703-941-8089
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAM472OtherCAREFIRST BC BS
VA245673OtherANTHEM BCBS
VA7389023OtherAETNA