Provider Demographics
NPI:1629506746
Name:ANDERSON, ANNE CHAMPAGNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CHAMPAGNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2019
Mailing Address - Country:US
Mailing Address - Phone:808-969-1733
Mailing Address - Fax:808-969-4863
Practice Address - Street 1:1011 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2019
Practice Address - Country:US
Practice Address - Phone:808-969-1733
Practice Address - Fax:808-969-4863
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-41541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical