Provider Demographics
NPI:1649601048
Name:ANDERSON, RAY JR (MPH, MED)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MPH, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HIGHWAY 160 W
Mailing Address - Street 2:16
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8401
Mailing Address - Country:US
Mailing Address - Phone:314-518-0042
Mailing Address - Fax:803-403-8916
Practice Address - Street 1:2012 HIGHWAY 160 W
Practice Address - Street 2:SUITE 16
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8401
Practice Address - Country:US
Practice Address - Phone:980-404-2365
Practice Address - Fax:803-403-8916
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst