Provider Demographics
NPI:1962464750
Name:ANDERSON, ROBERT EARL (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 THIMBLE SHOALS BLVD STE 906
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4218
Mailing Address - Country:US
Mailing Address - Phone:757-707-6640
Mailing Address - Fax:757-223-1113
Practice Address - Street 1:732 THIMBLE SHOALS BLVD STE 906
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-707-6640
Practice Address - Fax:757-223-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA143599OtherHEALTHKEEPERS
VA143599Medicaid
VA737875000OtherMAGELLAN
VAO84686MOtherSOUTHERN HEALTH
VA143599OtherANTHEM
VA004945115Medicaid
VA365945OtherTRICARE
VAO84686MMedicaid
VA7471623OtherAETNA