Provider Demographics
NPI:1932638376
Name:ANDERSON DEVELOPMENT LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:ANDERSON DEVELOPMENT LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:THE ANDERSON CENTER FOR PERSONAL DEVELOPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-745-8847
Mailing Address - Street 1:21151 S WESTERN AVE STE 174
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1724
Mailing Address - Country:US
Mailing Address - Phone:310-745-8847
Mailing Address - Fax:
Practice Address - Street 1:21151 S WESTERN AVE STE 174
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:310-745-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty