Provider Demographics
NPI:1801859541
Name:ANDERSON, MICHAEL LAWRENCE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 183RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6834
Mailing Address - Country:US
Mailing Address - Phone:253-862-8908
Mailing Address - Fax:
Practice Address - Street 1:9040A REID STREET
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-6860
Practice Address - Fax:253-968-5834
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009420941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical