Provider Demographics
NPI:1790966729
Name:ANDERSON, JEANNE E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:E
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:606 WALTER REED DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1114
Mailing Address - Country:US
Mailing Address - Phone:336-547-1574
Mailing Address - Fax:336-323-5247
Practice Address - Street 1:606 WALTER REED DR STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1114
Practice Address - Country:US
Practice Address - Phone:336-547-1574
Practice Address - Fax:336-323-5247
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2212103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790966729Medicaid
NC1790966729Medicaid