Provider Demographics
NPI:1811010622
Name:ANDERSON, JAMES CLIFTON (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLIFTON
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SPINNAKER CT
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7102
Mailing Address - Country:US
Mailing Address - Phone:704-896-5759
Mailing Address - Fax:704-342-1917
Practice Address - Street 1:1409 EAST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5817
Practice Address - Country:US
Practice Address - Phone:704-338-1155
Practice Address - Fax:704-342-1917
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional