Provider Demographics
NPI:1932690690
Name:ANDERSON, ARTISE L (CDCA, QMHS)
Entity Type:Individual
Prefix:MR
First Name:ARTISE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CDCA, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44901-1316
Mailing Address - Country:US
Mailing Address - Phone:419-525-3525
Mailing Address - Fax:419-525-3355
Practice Address - Street 1:400 BOWMAN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-1235
Practice Address - Country:US
Practice Address - Phone:419-525-3525
Practice Address - Fax:419-525-3355
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150195101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)