Provider Demographics
NPI:1679332258
Name:ANDERS, LAVINA MAE (BS, SC)
Entity Type:Individual
Prefix:MRS
First Name:LAVINA
Middle Name:MAE
Last Name:ANDERS
Suffix:
Gender:F
Credentials:BS, SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2637
Mailing Address - Country:US
Mailing Address - Phone:304-533-8100
Mailing Address - Fax:
Practice Address - Street 1:1303 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1333
Practice Address - Country:US
Practice Address - Phone:304-553-0010
Practice Address - Fax:304-699-2141
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)