Provider Demographics
NPI:1689775009
Name:DUNGEE-ANDERSON, ELIZABETH DELORES (PHD; LCSW)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DELORES
Last Name:DUNGEE-ANDERSON
Suffix:
Gender:F
Credentials:PHD; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 HUGUENOT RD STE 303
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4311
Mailing Address - Country:US
Mailing Address - Phone:804-794-6247
Mailing Address - Fax:804-794-6247
Practice Address - Street 1:1901 HUGUENOT RD
Practice Address - Street 2:SUITE 303
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4311
Practice Address - Country:US
Practice Address - Phone:804-840-1149
Practice Address - Fax:804-562-4550
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008916209Medicaid