Provider Demographics
NPI:1790966935
Name:ANDERS, PAUL FRANKLIN III (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FRANKLIN
Last Name:ANDERS
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 SUMMER POND DR APT H
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4632
Mailing Address - Country:US
Mailing Address - Phone:703-618-4828
Mailing Address - Fax:
Practice Address - Street 1:9901 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1904
Practice Address - Country:US
Practice Address - Phone:703-764-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003471103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical