Provider Demographics
NPI:1942481882
Name:ANDERSON, JASON DEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DEAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CELEBRATION BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5585
Mailing Address - Country:US
Mailing Address - Phone:843-536-1180
Mailing Address - Fax:843-536-1116
Practice Address - Street 1:1340 CELEBRATION BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5585
Practice Address - Country:US
Practice Address - Phone:843-536-1180
Practice Address - Fax:843-536-1116
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical