Provider Demographics
NPI:1710064845
Name:ANDERSON, DONALD (LPC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 ELECTRIC RD STE 156
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4571
Mailing Address - Country:US
Mailing Address - Phone:540-797-0569
Mailing Address - Fax:540-387-1047
Practice Address - Street 1:3959 ELECTRIC RD STE 156
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4571
Practice Address - Country:US
Practice Address - Phone:540-797-0569
Practice Address - Fax:540-387-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000655101YM0800X
VA0701000664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional