Provider Demographics
NPI:1134195183
Name:ANDERTON, CHARLES HENRY JR (PH D)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HENRY
Last Name:ANDERTON
Suffix:JR
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 WASHINGTON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-3270
Mailing Address - Country:US
Mailing Address - Phone:919-821-4900
Mailing Address - Fax:
Practice Address - Street 1:855 WASHINGTON STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-3270
Practice Address - Country:US
Practice Address - Phone:919-821-4900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03185OtherBLUE CROSS BLUE SHIELD
34727OtherNATL REGISTER OF HEALTH
34727OtherNATL REGISTER OF HEALTH