Provider Demographics
NPI:1609247188
Name:ANDERSON, TOWANNA (LPC)
Entity Type:Individual
Prefix:
First Name:TOWANNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5027
Mailing Address - Country:US
Mailing Address - Phone:601-529-6889
Mailing Address - Fax:
Practice Address - Street 1:1700 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-5208
Practice Address - Country:US
Practice Address - Phone:318-559-0551
Practice Address - Fax:318-559-0538
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional