Provider Demographics
NPI:1821128117
Name:ANDERSON, MARTHA JOHNSON (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JOHNSON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 GRAY FRYAR RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1116
Mailing Address - Country:US
Mailing Address - Phone:423-886-1672
Mailing Address - Fax:423-493-5718
Practice Address - Street 1:701 CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3325
Practice Address - Country:US
Practice Address - Phone:423-653-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health