Provider Demographics
NPI:1720555162
Name:ANDERSON, ANALISE MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANALISE
Middle Name:MAE
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 1:612 N GREENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2024
Mailing Address - Country:US
Mailing Address - Phone:336-604-5100
Mailing Address - Fax:336-604-5151
Practice Address - Street 1:612 N GREENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2024
Practice Address - Country:US
Practice Address - Phone:336-604-5100
Practice Address - Fax:336-604-5151
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0113201041C0700X
NCC0129161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical