Provider Demographics
NPI:1629416029
Name:ANDERSON COUNSELING AND CONSULTING GROUP, PLLC
Entity Type:Organization
Organization Name:ANDERSON COUNSELING AND CONSULTING GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RULONDO
Authorized Official - Middle Name:TEHRAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-252-4381
Mailing Address - Street 1:2013 BEECHMONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8365
Mailing Address - Country:US
Mailing Address - Phone:704-208-4458
Mailing Address - Fax:866-309-6385
Practice Address - Street 1:1923 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4534
Practice Address - Country:US
Practice Address - Phone:704-208-4458
Practice Address - Fax:866-309-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9371101YP2500X, 251S00000X, 251S00000X, 101YP2500X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6115004Medicaid