Provider Demographics
NPI:1184716482
Name:ANDERSON, MARTHA LEWIS (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LEWIS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:LEWIS
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3310 EAGLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-8106
Mailing Address - Country:US
Mailing Address - Phone:540-449-2593
Mailing Address - Fax:540-382-9010
Practice Address - Street 1:3310 EAGLEBROOK DR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-8106
Practice Address - Country:US
Practice Address - Phone:540-449-2593
Practice Address - Fax:540-382-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA208449OtherANTHEME LPC
VA84523OtherSENTARA
VA005400805Medicaid